Guest guest Posted June 21, 2001 Report Share Posted June 21, 2001 In a message dated 6/19/01 4:39:15 AM Eastern Daylight Time, duodenalswitch writes: << Who should come out, but Dr Anthone. He spent the better part of an hour talking with me, answering questions, providing me with studies and articles. Mind you, I had no appointment, he wasn't getting paid to talk to me, and I'm sure he had better things to do with his lunch break than visit with this odd woman who had a 3 year old in tow. But he wasn't hurried, kept asking me if I had more questions, volunteered the information about his 3 fatalities, and just made sure I was comfortable. >> Ok, so you mention 3 fatalities - please explain, if you could. I have read up on the Dr. Ren thing and I think it might have happened because of Deb's previous surgery. I know no surgery is without risks. But I want to know more about the fatalities, please. Carole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2001 Report Share Posted June 21, 2001 --- MsMystic1@... wrote: > In a message dated 6/19/01 4:39:15 AM Eastern > Daylight Time, > duodenalswitch writes: .. > I have read up on the Dr. Ren thing and I think it > might have happened > because of Deb's previous surgery. Could someone please tell me what the " Dr. Ren thing " is. I am considering her for surgery. Thanks, __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2001 Report Share Posted June 21, 2001 > Ok, so you mention 3 fatalities - please explain, if you could. Hi Carol: I think I can answer that question in regard to Dr. Anthone. The three fatalities he had were all caused by blood clots which developed in the legs and then broke off and moved to the more vital organs. (I think it was the lungs in at least two of the three cases, but don't quote me on that, as it's been a while since I discussed this with him.) All three cases occured after the patient had left the hospital and was recuperating at home. Morbidly obese people are particularly susceptible to blood clots because of our relative immobility. Lack of mobility can lead directly to the development of blood clots in the legs, even in " normal " weight people. (You may remember that Vice President Dan Quayle developed a blood clot in his leg just from sitting still too long on an airplane.) This is why it is so important that we MO patients get up and at least walk as soon and as often as possible after ANY surgery. Dr. Anthone remains quite concerned about this issue, and takes several steps to prevent it ever reoccuring. For patients who are still in the hospital, he begins Heparin treatment just prior to surgery, (the anesthesiologist administers the first dose in the O.R.), and continues it for the duration of the hospital stay. (Heparin is a drug that prevents the clotting of blood.) Air powered " leg squeezers, " (I don't know the technical name), are applied to your calves while you are resting. (They squeeze and release your calf muscles continuously, so that blood does not pool down there.) In addition, by the second day after surgery, the nurses begin force marching you around the floor, (central line, Foley catheter, drain tubes, and all). Once the patient has left the hospital it is, of course, more difficult for the surgeon to make that person get up and walk around. And for the larger patients, mobility is quite a problem even prior to surgery. For example, Dr. A currently has a patient who (at 5'6 " tall) weighed 680 lbs at his initial consultation. (That's a BMI of 109.75.) Simply walking to the bathroom has been a struggle for this fellow for years. Walking for exercise is pretty much out of the question. This difficulty with post-surgical mobility is why Dr. Anthone started performing a panniculectomy on his larger patients PRIOR to the DS. For most DS patients, a panni is just used to deal with hanging skin left after weight loss. (It's commonly known as a " tummy tuck. " ) But, during the pre-DS panni, Dr. Anthone removes anywhere from 20 to 50+ pounds of hanging belly fat. This may not seem like all that much, considering some of our starting weights, but for those of us whose bellies used to hang down and force our legs apart when we sat, it makes a significant difference. For example, prior to my panni, my lower back pain was horrendous, it was only with extreme difficulty that I could put on my own shoes, and walking was torture. After the panni, my lower back pain abated somewhat, I could easily sit and put on my own shoes, and walking was noticibly easier. It wasn't a miracle, but it did help me become mobile more quickly after my DS. The moral of this story is, make sure that you are absolutely committed to (and capable of) getting up and walking around after your DS surgery. If not, it might be a good idea to see a cardiologist about multi-month treatment with some sort of blood thinner. HTH Tom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2001 Report Share Posted June 21, 2001 > Could someone please tell me what the " Dr. Ren thing " > is. I am considering her for surgery. Hi : Deb, (the patient involvedin the " Dr. Ren thing " ), has a Yahoo Group where she has posted her views on the " Dr. Ren thing. " (Note to moderator. She changed the name and, as far as I could tell, removed the kind of characterizations we were worried about.) The address of the group is: http://groups.yahoo.com/group/NYUMC- TheTruthAboutRen> With trepidation, Tom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 21, 2001 Report Share Posted June 21, 2001 > > > Could someone please tell me what the " Dr. Ren thing " > > is. I am considering her for surgery. > Hi - I received a similar email warning me about Dr. Ren and I hadn't even looked at her yet as a possible surgeon. It was weird. Highly confused, Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2001 Report Share Posted June 22, 2001 --- Tom, I have heard a few people who have had a panni after weight loss describe the pain as much more severe than the original surgery. Was this operation very painful for you? How long was your recovery from this and how long did you have to wait until you had the DS afterwards. I could probably benifit from having this done prior to surgery, but would be afraid that if it were too painful, I may chicken out of the DS surgery. Also, any ideas why some doctors use the green filter to prevent blood clots and others don't. It seems like a good precautinary thing to do, unless it has risks of its own. Shirley In duodenalswitch@y..., tlarussa@p... wrote: > > > > Ok, so you mention 3 fatalities - please explain, if you could. > > Hi Carol: > > I think I can answer that question in regard to Dr. Anthone. > > The three fatalities he had were all caused by blood clots which > developed in the legs and then broke off and moved to the more vital > organs. (I think it was the lungs in at least two of the three > cases, but don't quote me on that, as it's been a while since I > discussed this with him.) All three cases occured after the patient > had left the hospital and was recuperating at home. > > Morbidly obese people are particularly susceptible to blood clots > because of our relative immobility. Lack of mobility can lead > directly to the development of blood clots in the legs, even > in " normal " weight people. (You may remember that Vice President Dan > Quayle developed a blood clot in his leg just from sitting still too > long on an airplane.) This is why it is so important that we MO > patients get up and at least walk as soon and as often as possible > after ANY surgery. > > Dr. Anthone remains quite concerned about this issue, and takes > several steps to prevent it ever reoccuring. > > For patients who are still in the hospital, he begins Heparin > treatment just prior to surgery, (the anesthesiologist administers > the first dose in the O.R.), and continues it for the duration of the > hospital stay. (Heparin is a drug that prevents the clotting of > blood.) Air powered " leg squeezers, " (I don't know the technical > name), are applied to your calves while you are resting. (They > squeeze and release your calf muscles continuously, so that blood > does not pool down there.) In addition, by the second day after > surgery, the nurses begin force marching you around the floor, > (central line, Foley catheter, drain tubes, and all). > > Once the patient has left the hospital it is, of course, more > difficult for the surgeon to make that person get up and walk > around. And for the larger patients, mobility is quite a problem > even prior to surgery. For example, Dr. A currently has a patient > who (at 5'6 " tall) weighed 680 lbs at his initial consultation. > (That's a BMI of 109.75.) Simply walking to the bathroom has been a > struggle for this fellow for years. Walking for exercise is pretty > much out of the question. > > This difficulty with post-surgical mobility is why Dr. Anthone > started performing a panniculectomy on his larger patients PRIOR to > the DS. For most DS patients, a panni is just used to deal with > hanging skin left after weight loss. (It's commonly known as > a " tummy tuck. " ) But, during the pre-DS panni, Dr. Anthone removes > anywhere from 20 to 50+ pounds of hanging belly fat. > > This may not seem like all that much, considering some of our > starting weights, but for those of us whose bellies used to hang down > and force our legs apart when we sat, it makes a significant > difference. For example, prior to my panni, my lower back pain was > horrendous, it was only with extreme difficulty that I could put on > my own shoes, and walking was torture. After the panni, my lower > back pain abated somewhat, I could easily sit and put on my own > shoes, and walking was noticibly easier. It wasn't a miracle, but it > did help me become mobile more quickly after my DS. > > The moral of this story is, make sure that you are absolutely > committed to (and capable of) getting up and walking around after > your DS surgery. If not, it might be a good idea to see a > cardiologist about multi-month treatment with some sort of blood > thinner. > > HTH > > Tom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2001 Report Share Posted June 22, 2001 I'm pre-op and I was wondering if there are any symptoms that may help you identify clots before it's too late? Besides walking, is there anything else you can do to prevent this from occuring? Tachia > In a message dated 6/19/01 4:39:15 AM Eastern Daylight Time, > duodenalswitch@y... writes: > > << Who should come out, but Dr Anthone. He spent the better part of > an hour talking with me, answering questions, providing me with studies and > articles. Mind you, I had no appointment, he wasn't getting paid to talk to > me, and I'm sure he had better things to do with his lunch break than visit > with this odd woman who had a 3 year old in tow. But he wasn't hurried, > kept asking me if I had more questions, volunteered the information about > his 3 fatalities, and just made sure I was comfortable. >> > Ok, so you mention 3 fatalities - please explain, if you could. > I have read up on the Dr. Ren thing and I think it might have happened > because of Deb's previous surgery. > I know no surgery is without risks. But I want to know more about the > fatalities, please. > Carole Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 22, 2001 Report Share Posted June 22, 2001 At 2:49 AM +0000 6/23/01, 1tachia@... wrote: >I'm pre-op and I was wondering if there are any symptoms that may >help you identify clots before it's too late? Depends. DVT (deep venous thromboses) can be very painful in the legs. If you get a localized and excruciating pain in your leg, like a terrible cramp that won't go away, get on the phone to your doc or go to the emergency room ASAP. > >Besides walking, is there anything else you can do to prevent this >from occuring? Your surgeon can order blood thinners (many do). You can be religious with your breathing exercises post-op, but that won't really do much for blood clots. > >Tachia -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2001 Report Share Posted June 23, 2001 stacy: one thing i have kept in mind is that not everyone is going to like every surgeon. even the good drs are going to have those that don't like them. i have only found one person who is against dr ren and i don't think she has too much of a case. just ck into things yourself. i have consulted with a couple drs before making my mind up. your pcp can give you referals for as many consults as you want..(i think within reason) interview them and make your own decision. cheryl ps just my two cents/ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 23, 2001 Report Share Posted June 23, 2001 >i > have only found one person who is against dr ren and i don't think she has > too much of a case. Amazing. The poor woman has no quality of life due to a poor clinical judgement made by her surgeon, yet she " doesn't have much of a case " .. God help you if you have a similar mishap... oh wait.. that would be different, wouldn't it? Liane Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2001 Report Share Posted June 24, 2001 liana: i am sorry that you took offense to my email. i read the web site of the woman that had problems with dr ren. she is the only one i heard that had a problem. I have heard many people say what a great dr she is. i don't want to get in a debate with anyone over her case. i am only able to understand what i have read and did not hear the other side either. i didn't realize she has no quality of life. i guess we are all going into this with a certain risk factor. even at half of a percent that is one out of two hundred. we have to come to realize we may be that one. most surgeons have had at least one mortality. (i would imagine) i am very sorry for the woman with the problem. but the surgeon sd it was done to save her life. if it comes to dieing for whatever complication, i would hope my surgeon would do whatever is necessary to keep my life. can she function in life? is she terminal? maybe i am missing something, but i have never meant to be offensive to anyone and my appologies to all. cheryl Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2001 Report Share Posted June 24, 2001 She's not terminal, yet. But she gets sick after every single meal from dumping, wakes up with reflux every single day that will eventually erode her esophagus, has horrible halitosis because, since her anastomosis forms a " straight pipe " with no bends, odors rise from her bowels straight up through her mouth, experiences excruciating pain several times daily, and will, even with supplementation, probably end up having some vitamin/mineral deficiencies down the road. Her insurance company (Blue Cross/Blue Shield) thinks enough of her case that they have stopped approving the DS. I was offended only because her case is severe. It will affect her for the rest of her life, and as a newbie who wants to know everything, I would think this was important. It was nothing you intended to do, I'm sure.. but she has a heck of a case. I'm not mad at you, nor do I dislike you.. but never assume that its not a bad deal just because the patient didn't die. Hugs, Liane > liana: > i am sorry that you took offense to my email. i read the web site of the > woman that had problems with dr ren. she is the only one i heard that had a > problem. I have heard many people say what a great dr she is. i don't want to > get in a debate with anyone over her case. i am only able to understand what > i have read and did not hear the other side either. i didn't realize she has > no quality of life. i guess we are all going into this with a certain risk > factor. even at half of a percent that is one out of two hundred. we have to > come to realize we may be that one. most surgeons have had at least one > mortality. (i would imagine) i am very sorry for the woman with the problem. > but the surgeon sd it was done to save her life. if it comes to dieing for > whatever complication, i would hope my surgeon would do whatever is necessary > to keep my life. can she function in life? is she terminal? maybe i am > missing something, but i have never meant to be offensive to anyone and my > appologies to all. > cheryl Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2001 Report Share Posted June 24, 2001 NOTE TO ALL: I am really, really, really hesitant to write this, but I think somebody should, and since I'm already pretty crispy from being a lightning rod for criticism, it might as well be me. > but the surgeon sd it was done to save her life. > if it comes to dieing for whatever complication, > i would hope my surgeon would do whatever is > necessary to keep my life. Hi Cheryl: I'm not going to flame you, or " yell " at you or anything like that, but I think it's possible that you did miss something. Following is an excerpt from Dr. Ren's surgical note on Deb's surgery. Note that I have excised portions that are not relevant to the present discussion. Excised portions are denoted by an elipsis, i.e., " . . . " " There were significant adhesions around the pylorus and duodenum to the liver and surrounding fat. These adhesions were lysed using the ultrasonic scalpel as well as blunt dissection. The dissection of this area was approached posteriorly. The gastroduodenal artery was not visualized at any time. The superior portion of the proximal duodenum was dissected off its surrounding structures so that the first 2 cm of the duodenum was circumferentially mobilized. . . . The duodenum was divided 2cm distal to the pylorus . . . After division of the duodenum, it was noted that the proximal duodenal cuff and the pylorus were dusky, suggesting ischemia. Due to the high risk for ensuing necrosis and possible anastomotic leak, the decision was made to resect the distal 3cm of the gastric pouch which included the pylorus and duodenal cuff. The resulting gastric pouch staple line was pink and viable. " In order to get a handle on all of this stuff, I had to do some research. I'm pasting in the relevant portions here, along with where I found them, so anybody else can look up the same thing and compare their conclusions to my own. First, some definitions, which I got from the medical dictionary at Medscape.com. ADHESION = " the abnormal union of surfaces normally separate by the formation of new fibrous tissue resulting from an inflammatory process " LYSED = disintegrated or dissolved; derived from " LYSIS " which means " a process of disintegration or dissolution. " ISCHEMIA: " localized tissue anemia due to obstruction of the inflow of arterial blood " PYLORUS: " the opening from the vertebrate stomach into the intestine " I found a great book-length document about the Pyloric Region. It helps me, (as much as I can with my layperson's mind), understand how the area is structured and, most important for the present discussion, how the blood is supplied to the region. Here are some quotes from A.D. Keet, " The Pyloric Sphinter in Health and Disease, " located at http://med.plig.org/index.html> " The second branch of the coeliac trunk, the hepatic artery, passes downwards as far as the first part of the duodenum. It then turns forwards at the opening into the lesser sac (epiploic foramen) and curves upwards into the space between the two layers of the lesser omentum towards the porta hepatis, to supply the liver. As it turns into the lesser omentum the hepatic artery gives off the gastro- duodenal and right gastric arteries. " " The gastro-duodenal artery passes downwards behind the first part of the duodenum, which it supplies by multiple small branches; it then divides into the superior pancreatico-duodenal artery, supplying the second part of the duodenum and head of the pancreas, and the right gastro-epiploic artery. " " The first 2 cm of the duodenum is supplied by multiple small branches from the hepatic and gastroduodenal arteries (Last l984). According to Cunningham (l947) the first part of the duodenum occupies the frontier zone between the coeliac and superior mesenteric vascular supplies, and the vessels which supply it vary considerably in their size and mode of origin; the peculiarity of its blood supply may partly account for the frequency with which it is the seat of ulceration. " Finally, in order to understand how the DS is supposed to be performed, I looked to the " father of our surgery, " Dr. Hess. His article is available on Duodenalswitch.com. Dr. Hess Quote: " the duodenum is transected as far distal to the pylorus as possible (generally 4 to 5 centimeters). " Okay, now we leave the realm of medicine and enter the realm of analysis. NOTE: THE REMAINDER OF THIS POST IS MY OPINION, BASED ON THE RESEARCH LAID OUT ABOVE, ABOUT DEB'S SURGERY. I AM NOT A MEDICAL PROFESSIONAL, AND I HAVE ABSOLUTELY NO EXPERTISE WHATSOEVER IN MEDICINE OR ANY MEDICINE-RELATED FIELD. YOU MAY READ EXACTLY THE SAME SOURCES AND REACH DIAMETRICALLY OPPOSED CONCLUSIONS. IF YOU EXPLAIN YOUR REASONING TO ME NICELY, I WILL CONSIDER IT AND (POSSIBLY) CHANGE MY OWN VIEWS IN RESPONSE. BUT BE FOREWARNED, IN ORDER TO MAKE ME CHANGE MY VIEWS, YOU WILL FIRST HAVE TO DEMONSTRATE THAT YOU UNDERSTAND ALL OF THIS STUFF BETTER THAN I DO. Now then, with all those disclaimers in place, here is why I am troubled by Dr. Ren's report of her own actions during Deb's surgery. 1. Dr. Ren states that, " [t]he gastroduodenal artery was not visualized at any time. Given that, (according to Keet's article), the gastroduodenal artery supplies blood to the first portion of the duodenum, I would think that finding it prior to cutting anything would be rather important, so that one could avoid cutting it by accident. It seems to me this is a matter of simple logic. Dr. Ren says nothing about whether she located the Hepatic artery, so I have to assume she did not. For the same reasons as with the gastroduodenal artery, simple logic tells me that locating this artery prior to cutting anything might be a really good idea. We know for sure that the first part of Deb's duodenum lost its blood supply, so it appears that, NOT finding either of these arteries prior to cutting might have been a serious error on Dr. Ren's part. That is, it appears to be possible that Dr. Ren herself cut off the blood supply, either while cutting away all of those adhesions, or by cutting the duodenum itself without first locating its blood supply. 2. If Dr. Ren could not locate the blood supply through arthroscopic means, why didn't she switch to an open procdure and continue looking? Maybe this wouldn't have helped at all. I don't have the knowledge to say for sure. But simple logic tells me it couldn't have hurt, and it might have helped a lot. 3. Dr. Ren mobilized the first 2 cm of the duodenum, and then cut it just two cm from the pylorus. According to Dr. Hess, this cut should be made as far from the pylorus as possible, which is generally four to five cm. Why didn't Dr. Ren cut the duodenum farther away from the pylorus? The only reason I can come up with is that cutting say, five cm from the pylorus would have required mobilizing the first five, (rather than two), cm of the duodenum. This would have taken two and a half times as long. Did Dr. Ren rush through this portion of the operation? Perhaps cutting away all those adhesions took a long time, and she was worried about getting behind schedule. I can't say for sure, obviously, but that's the impression I get. And isn't it possible, from a strictly logical viewpoint, that Dr. Ren severed the blood supply, (which she had not located), by cutting the duodenum too close to the pylorus? 3. Dr. Ren did not perform the " Switch " portion of the operation. Thus, the surgery that Deb received was not the BPD/DS she bargained for, but more like a botched BPD without the DS. This is quite significant, because it is the Duodenal Switch portion of the operation that protects us from having duodenal juice, (i.e., bile) back up into the stomach, where it can then be refluxed into the esophagus. Research at USC has found that refluxing stomach acid by itself is not nearly as harmful as refluxing bile. This information is available here: http://www.surgery.usc.edu/foregut/gerd.html> " [R]ecent research by members of the Thoracic-Foregut Group into the actual contents of the reflux has resulted in some fascinating findings. Their research has shown that about 50 percent of people reflux both gastric (acid) and duodenal (bile) contents - and these individuals are the patients who tend to get Barrett's metaplasia, as opposed to those people who only reflux acid. (ls of Surgery, October 1995, Vol. 222, No. 4, 523-533). Members of the Thoracic- Foregut Group took this research one step further. " When we caused the reflux of both bile and acid in animal models, " says Dr. DeMeester, " we found a high incidence of both Barrett's and adenocarcinoma. In addition, this research indicated that when acid is not present in the reflux, the incidence of tumors dramatically increases-indicating that the noxious agent in reflux is duodenal juice, and that acid can play a protective role. The animals that had acid present had a lower incidence of tumors. " (ls of Surgery, September 1996, Vol. 224, No. 3). (NOTE: Dr. DeMeester, who is quoted above, is the surgeon who created the Duodenal Switch procedure, (for the treatment of patients with chronic bile reflux). Dr. Hess combined this with Dr. Scopinaro's BPD to create the BPD/DS.) So, what does all this mean? Deb wanted the BPD/DS, which prevents bile reflux and eliminates dumping. What she got was something altogether different. Deb was left with a tubular stomach leading directly into her small intestine. Anything she eats or drinks has nothing to hold it in the stomach so that it can mix with acid, so it probably all just goes straight into the intestinal tract. Thus, instead of NO dumping, Deb probably has nearly 100% dumping. Secondly, because there was no DS performed, and no pyloric valve preserved, there is nothing to stop bile from flowing up into her tubular stomach, there to be refluxed into her esophagus, with all of the potential nastiness which that entails. In conclusion, to my mind, there is good reason to question Dr. Ren's actions during Deb's surgery as well as (possibly) her judgment. THIS IS JUST MY OPINION! Tom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2001 Report Share Posted June 24, 2001 I know someone mentioned it before so I was wondering what is Deb's website? Thanks for doing the research Tom. Lisbeth Tomorrow Dr. Macura --- tlarussa@... wrote: > > > NOTE TO ALL: I am really, really, really hesitant > to write this, but > I think somebody should, and since I'm already > pretty crispy from > being a lightning rod for criticism, it might as > well be me. > > > but the surgeon sd it was done to save her life. > > if it comes to dieing for whatever complication, > > i would hope my surgeon would do whatever is > > necessary to keep my life. > > > Hi Cheryl: > > I'm not going to flame you, or " yell " at you or > anything like that, > but I think it's possible that you did miss > something. > > Following is an excerpt from Dr. Ren's surgical note > on Deb's > surgery. Note that I have excised portions that are > not relevant to > the present discussion. Excised portions are > denoted by an elipsis, > i.e., " . . . " > > " There were significant adhesions around the pylorus > and duodenum to > the liver and surrounding fat. These adhesions were > lysed using the > ultrasonic scalpel as well as blunt dissection. The > dissection of > this area was approached posteriorly. The > gastroduodenal artery was > not visualized at any time. The superior portion of > the proximal > duodenum was dissected off its surrounding > structures so that the > first 2 cm of the duodenum was circumferentially > mobilized. > > . . . The duodenum was divided 2cm distal to the > pylorus . . . > After division of the duodenum, it was noted that > the > proximal duodenal cuff and the pylorus were dusky, > suggesting > ischemia. Due to the high risk for ensuing necrosis > and possible > anastomotic leak, the decision was made to resect > the distal 3cm of > the gastric pouch which included the pylorus and > duodenal cuff. The > resulting gastric pouch staple line was pink and > viable. " > > > In order to get a handle on all of this stuff, I had > to do some > research. I'm pasting in the relevant portions > here, along with > where I found them, so anybody else can look up the > same thing and > compare their conclusions to my own. > > First, some definitions, which I got from the > medical dictionary at > Medscape.com. > > ADHESION = " the abnormal union of surfaces normally > separate by the > formation of new fibrous tissue resulting from an > inflammatory > process " > > LYSED = disintegrated or dissolved; derived from > " LYSIS " which > means " a process of disintegration or dissolution. " > > > ISCHEMIA: " localized tissue anemia due to > obstruction of the inflow > of arterial blood " > > PYLORUS: " the opening from the vertebrate stomach > into the intestine " > > > I found a great book-length document about the > Pyloric Region. It > helps me, (as much as I can with my layperson's > mind), understand how > the area is structured and, most important for the > present > discussion, how the blood is supplied to the region. > > > Here are some quotes from A.D. Keet, " The Pyloric > Sphinter in Health > and Disease, " located at > http://med.plig.org/index.html> > > " The second branch of the coeliac trunk, the hepatic > artery, passes > downwards as far as the first part of the duodenum. > It then turns > forwards at the opening into the lesser sac > (epiploic foramen) and > curves upwards into the space between the two layers > of the lesser > omentum towards the porta hepatis, to supply the > liver. As it turns > into the lesser omentum the hepatic artery gives off > the gastro- > duodenal and right gastric arteries. " > > " The gastro-duodenal artery passes downwards behind > the first part of > the duodenum, which it supplies by multiple small > branches; it then > divides into the superior pancreatico-duodenal > artery, supplying the > second part of the duodenum and head of the > pancreas, and the right > gastro-epiploic artery. " > > " The first 2 cm of the duodenum is supplied by > multiple small > branches from the hepatic and gastroduodenal > arteries (Last l984). > According to Cunningham (l947) the first part of the > duodenum > occupies the frontier zone between the coeliac and > superior > mesenteric vascular supplies, and the vessels which > supply it vary > considerably in their size and mode of origin; the > peculiarity of its > blood supply may partly account for the frequency > with which it is > the seat of ulceration. " > > > Finally, in order to understand how the DS is > supposed to be > performed, I looked to the " father of our surgery, " > Dr. Hess. His > article is available on Duodenalswitch.com. > > Dr. Hess Quote: " the duodenum is transected as far > distal to the > pylorus as possible (generally 4 to 5 centimeters). " > > > > Okay, now we leave the realm of medicine and enter > the realm of > analysis. > > NOTE: THE REMAINDER OF THIS POST IS MY OPINION, > BASED ON THE > RESEARCH LAID OUT ABOVE, ABOUT DEB'S SURGERY. I AM > NOT A MEDICAL > PROFESSIONAL, AND I HAVE ABSOLUTELY NO EXPERTISE > WHATSOEVER IN > MEDICINE OR ANY MEDICINE-RELATED FIELD. > > YOU MAY READ EXACTLY THE SAME SOURCES AND REACH > DIAMETRICALLY OPPOSED > CONCLUSIONS. IF YOU EXPLAIN YOUR REASONING TO ME > NICELY, I WILL > CONSIDER IT AND (POSSIBLY) CHANGE MY OWN VIEWS IN > RESPONSE. BUT BE > FOREWARNED, IN ORDER TO MAKE ME CHANGE MY VIEWS, YOU > WILL FIRST HAVE > TO DEMONSTRATE THAT YOU UNDERSTAND ALL OF THIS STUFF > BETTER THAN I > DO. > > > Now then, with all those disclaimers in place, here > is why I am > troubled by Dr. Ren's report of her own actions > during Deb's > surgery. > > 1. Dr. Ren states that, " [t]he gastroduodenal > artery was not > visualized at any time. > > Given that, (according to Keet's article), the > gastroduodenal artery > supplies blood to the first portion of the duodenum, > I would think > that finding it prior to cutting anything would be > rather important, > so that one could avoid cutting it by accident. It > seems === message truncated === __________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2001 Report Share Posted June 24, 2001 Thank you, Tom.. I didn't go into this because I was flamed in the past for it.. but your deductive logic is pretty flawless. Thank You. Hugs, Liane > > NOTE TO ALL: I am really, really, really hesitant to write this, but > I think somebody should, and since I'm already pretty crispy from > being a lightning rod for criticism, it might as well be me. > > > but the surgeon sd it was done to save her life. > > if it comes to dieing for whatever complication, > > i would hope my surgeon would do whatever is > > necessary to keep my life. > > > Hi Cheryl: > > I'm not going to flame you, or " yell " at you or anything like that, > but I think it's possible that you did miss something. > > Following is an excerpt from Dr. Ren's surgical note on Deb's > surgery. Note that I have excised portions that are not relevant to > the present discussion. Excised portions are denoted by an elipsis, > i.e., " . . . " > > " There were significant adhesions around the pylorus and duodenum to > the liver and surrounding fat. These adhesions were lysed using the > ultrasonic scalpel as well as blunt dissection. The dissection of > this area was approached posteriorly. The gastroduodenal artery was > not visualized at any time. The superior portion of the proximal > duodenum was dissected off its surrounding structures so that the > first 2 cm of the duodenum was circumferentially mobilized. > > . . . The duodenum was divided 2cm distal to the pylorus . . . > After division of the duodenum, it was noted that the > proximal duodenal cuff and the pylorus were dusky, suggesting > ischemia. Due to the high risk for ensuing necrosis and possible > anastomotic leak, the decision was made to resect the distal 3cm of > the gastric pouch which included the pylorus and duodenal cuff. The > resulting gastric pouch staple line was pink and viable. " > > > In order to get a handle on all of this stuff, I had to do some > research. I'm pasting in the relevant portions here, along with > where I found them, so anybody else can look up the same thing and > compare their conclusions to my own. > > First, some definitions, which I got from the medical dictionary at > Medscape.com. > > ADHESION = " the abnormal union of surfaces normally separate by the > formation of new fibrous tissue resulting from an inflammatory > process " > > LYSED = disintegrated or dissolved; derived from " LYSIS " which > means " a process of disintegration or dissolution. " > > ISCHEMIA: " localized tissue anemia due to obstruction of the inflow > of arterial blood " > > PYLORUS: " the opening from the vertebrate stomach into the intestine " > > > I found a great book-length document about the Pyloric Region. It > helps me, (as much as I can with my layperson's mind), understand how > the area is structured and, most important for the present > discussion, how the blood is supplied to the region. > > Here are some quotes from A.D. Keet, " The Pyloric Sphinter in Health > and Disease, " located at http://med.plig.org/index.html> > > " The second branch of the coeliac trunk, the hepatic artery, passes > downwards as far as the first part of the duodenum. It then turns > forwards at the opening into the lesser sac (epiploic foramen) and > curves upwards into the space between the two layers of the lesser > omentum towards the porta hepatis, to supply the liver. As it turns > into the lesser omentum the hepatic artery gives off the gastro- > duodenal and right gastric arteries. " > > " The gastro-duodenal artery passes downwards behind the first part of > the duodenum, which it supplies by multiple small branches; it then > divides into the superior pancreatico-duodenal artery, supplying the > second part of the duodenum and head of the pancreas, and the right > gastro-epiploic artery. " > > " The first 2 cm of the duodenum is supplied by multiple small > branches from the hepatic and gastroduodenal arteries (Last l984). > According to Cunningham (l947) the first part of the duodenum > occupies the frontier zone between the coeliac and superior > mesenteric vascular supplies, and the vessels which supply it vary > considerably in their size and mode of origin; the peculiarity of its > blood supply may partly account for the frequency with which it is > the seat of ulceration. " > > > Finally, in order to understand how the DS is supposed to be > performed, I looked to the " father of our surgery, " Dr. Hess. His > article is available on Duodenalswitch.com. > > Dr. Hess Quote: " the duodenum is transected as far distal to the > pylorus as possible (generally 4 to 5 centimeters). " > > > Okay, now we leave the realm of medicine and enter the realm of > analysis. > > NOTE: THE REMAINDER OF THIS POST IS MY OPINION, BASED ON THE > RESEARCH LAID OUT ABOVE, ABOUT DEB'S SURGERY. I AM NOT A MEDICAL > PROFESSIONAL, AND I HAVE ABSOLUTELY NO EXPERTISE WHATSOEVER IN > MEDICINE OR ANY MEDICINE-RELATED FIELD. > > YOU MAY READ EXACTLY THE SAME SOURCES AND REACH DIAMETRICALLY OPPOSED > CONCLUSIONS. IF YOU EXPLAIN YOUR REASONING TO ME NICELY, I WILL > CONSIDER IT AND (POSSIBLY) CHANGE MY OWN VIEWS IN RESPONSE. BUT BE > FOREWARNED, IN ORDER TO MAKE ME CHANGE MY VIEWS, YOU WILL FIRST HAVE > TO DEMONSTRATE THAT YOU UNDERSTAND ALL OF THIS STUFF BETTER THAN I > DO. > > > Now then, with all those disclaimers in place, here is why I am > troubled by Dr. Ren's report of her own actions during Deb's > surgery. > > 1. Dr. Ren states that, " [t]he gastroduodenal artery was not > visualized at any time. > > Given that, (according to Keet's article), the gastroduodenal artery > supplies blood to the first portion of the duodenum, I would think > that finding it prior to cutting anything would be rather important, > so that one could avoid cutting it by accident. It seems to me this > is a matter of simple logic. > > Dr. Ren says nothing about whether she located the Hepatic artery, so > I have to assume she did not. > > For the same reasons as with the gastroduodenal artery, simple logic > tells me that locating this artery prior to cutting anything might be > a really good idea. > > We know for sure that the first part of Deb's duodenum lost its blood > supply, so it appears that, NOT finding either of these arteries > prior to cutting might have been a serious error on Dr. Ren's part. > That is, it appears to be possible that Dr. Ren herself cut off the > blood supply, either while cutting away all of those adhesions, or by > cutting the duodenum itself without first locating its blood supply. > > > 2. If Dr. Ren could not locate the blood supply through arthroscopic > means, why didn't she switch to an open procdure and continue > looking? Maybe this wouldn't have helped at all. I don't have the > knowledge to say for sure. But simple logic tells me it couldn't > have hurt, and it might have helped a lot. > > > 3. Dr. Ren mobilized the first 2 cm of the duodenum, and then cut it > just two cm from the pylorus. According to Dr. Hess, this cut should > be made as far from the pylorus as possible, which is generally four > to five cm. > > Why didn't Dr. Ren cut the duodenum farther away from the pylorus? > > The only reason I can come up with is that cutting say, five cm from > the pylorus would have required mobilizing the first five, (rather > than two), cm of the duodenum. This would have taken two and a half > times as long. > > Did Dr. Ren rush through this portion of the operation? Perhaps > cutting away all those adhesions took a long time, and she was > worried about getting behind schedule. I can't say for sure, > obviously, but that's the impression I get. And isn't it possible, > from a strictly logical viewpoint, that Dr. Ren severed the blood > supply, (which she had not located), by cutting the duodenum too > close to the pylorus? > > > 3. Dr. Ren did not perform the " Switch " portion of the operation. > Thus, the surgery that Deb received was not the BPD/DS she bargained > for, but more like a botched BPD without the DS. > > This is quite significant, because it is the Duodenal Switch portion > of the operation that protects us from having duodenal juice, (i.e., > bile) back up into the stomach, where it can then be refluxed into > the esophagus. > > Research at USC has found that refluxing stomach acid by itself is > not nearly as harmful as refluxing bile. This information is > available here: http://www.surgery.usc.edu/foregut/gerd.html> > > " [R]ecent research by members of the Thoracic-Foregut Group into the > actual contents of the reflux has resulted in some fascinating > findings. Their research has shown that about 50 percent of people > reflux both gastric (acid) and duodenal (bile) contents - and these > individuals are the patients who tend to get Barrett's metaplasia, as > opposed to those people who only reflux acid. (ls of Surgery, > October 1995, Vol. 222, No. 4, 523-533). Members of the Thoracic- > Foregut Group took this research one step further. " When we caused > the reflux of both bile and acid in animal models, " says Dr. > DeMeester, " we found a high incidence of both Barrett's and > adenocarcinoma. In addition, this research indicated that when acid > is not present in the reflux, the incidence of tumors dramatically > increases-indicating that the noxious agent in reflux is duodenal > juice, and that acid can play a protective role. The animals that had > acid present had a lower incidence of tumors. " (ls of Surgery, > September 1996, Vol. 224, No. 3). > > (NOTE: Dr. DeMeester, who is quoted above, is the surgeon who > created the Duodenal Switch procedure, (for the treatment of patients > with chronic bile reflux). Dr. Hess combined this with Dr. > Scopinaro's BPD to create the BPD/DS.) > > > So, what does all this mean? > > Deb wanted the BPD/DS, which prevents bile reflux and eliminates > dumping. What she got was something altogether different. > > Deb was left with a tubular stomach leading directly into her small > intestine. Anything she eats or drinks has nothing to hold it in the > stomach so that it can mix with acid, so it probably all just goes > straight into the intestinal tract. Thus, instead of NO dumping, Deb > probably has nearly 100% dumping. > > Secondly, because there was no DS performed, and no pyloric valve > preserved, there is nothing to stop bile from flowing up into her > tubular stomach, there to be refluxed into her esophagus, with all of > the potential nastiness which that entails. > > > In conclusion, to my mind, there is good reason to question Dr. Ren's > actions during Deb's surgery as well as (possibly) her judgment. > > THIS IS JUST MY OPINION! > > Tom Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 24, 2001 Report Share Posted June 24, 2001 http://groups.yahoo.com/group/NYUMC-TheTruthAboutRen > > > > NOTE TO ALL: I am really, really, really hesitant > > to write this, but > > I think somebody should, and since I'm already > > pretty crispy from > > being a lightning rod for criticism, it might as > > well be me. > > > > > but the surgeon sd it was done to save her life. > > > if it comes to dieing for whatever complication, > > > i would hope my surgeon would do whatever is > > > necessary to keep my life. > > > > > > Hi Cheryl: > > > > I'm not going to flame you, or " yell " at you or > > anything like that, > > but I think it's possible that you did miss > > something. > > > > Following is an excerpt from Dr. Ren's surgical note > > on Deb's > > surgery. Note that I have excised portions that are > > not relevant to > > the present discussion. Excised portions are > > denoted by an elipsis, > > i.e., " . . . " > > > > " There were significant adhesions around the pylorus > > and duodenum to > > the liver and surrounding fat. These adhesions were > > lysed using the > > ultrasonic scalpel as well as blunt dissection. The > > dissection of > > this area was approached posteriorly. The > > gastroduodenal artery was > > not visualized at any time. The superior portion of > > the proximal > > duodenum was dissected off its surrounding > > structures so that the > > first 2 cm of the duodenum was circumferentially > > mobilized. > > > > . . . The duodenum was divided 2cm distal to the > > pylorus . . . > > After division of the duodenum, it was noted that > > the > > proximal duodenal cuff and the pylorus were dusky, > > suggesting > > ischemia. Due to the high risk for ensuing necrosis > > and possible > > anastomotic leak, the decision was made to resect > > the distal 3cm of > > the gastric pouch which included the pylorus and > > duodenal cuff. The > > resulting gastric pouch staple line was pink and > > viable. " > > > > > > In order to get a handle on all of this stuff, I had > > to do some > > research. I'm pasting in the relevant portions > > here, along with > > where I found them, so anybody else can look up the > > same thing and > > compare their conclusions to my own. > > > > First, some definitions, which I got from the > > medical dictionary at > > Medscape.com. > > > > ADHESION = " the abnormal union of surfaces normally > > separate by the > > formation of new fibrous tissue resulting from an > > inflammatory > > process " > > > > LYSED = disintegrated or dissolved; derived from > > " LYSIS " which > > means " a process of disintegration or dissolution. " > > > > > > ISCHEMIA: " localized tissue anemia due to > > obstruction of the inflow > > of arterial blood " > > > > PYLORUS: " the opening from the vertebrate stomach > > into the intestine " > > > > > > I found a great book-length document about the > > Pyloric Region. It > > helps me, (as much as I can with my layperson's > > mind), understand how > > the area is structured and, most important for the > > present > > discussion, how the blood is supplied to the region. > > > > > > Here are some quotes from A.D. Keet, " The Pyloric > > Sphinter in Health > > and Disease, " located at > > http://med.plig.org/index.html> > > > > " The second branch of the coeliac trunk, the hepatic > > artery, passes > > downwards as far as the first part of the duodenum. > > It then turns > > forwards at the opening into the lesser sac > > (epiploic foramen) and > > curves upwards into the space between the two layers > > of the lesser > > omentum towards the porta hepatis, to supply the > > liver. As it turns > > into the lesser omentum the hepatic artery gives off > > the gastro- > > duodenal and right gastric arteries. " > > > > " The gastro-duodenal artery passes downwards behind > > the first part of > > the duodenum, which it supplies by multiple small > > branches; it then > > divides into the superior pancreatico-duodenal > > artery, supplying the > > second part of the duodenum and head of the > > pancreas, and the right > > gastro-epiploic artery. " > > > > " The first 2 cm of the duodenum is supplied by > > multiple small > > branches from the hepatic and gastroduodenal > > arteries (Last l984). > > According to Cunningham (l947) the first part of the > > duodenum > > occupies the frontier zone between the coeliac and > > superior > > mesenteric vascular supplies, and the vessels which > > supply it vary > > considerably in their size and mode of origin; the > > peculiarity of its > > blood supply may partly account for the frequency > > with which it is > > the seat of ulceration. " > > > > > > Finally, in order to understand how the DS is > > supposed to be > > performed, I looked to the " father of our surgery, " > > Dr. Hess. His > > article is available on Duodenalswitch.com. > > > > Dr. Hess Quote: " the duodenum is transected as far > > distal to the > > pylorus as possible (generally 4 to 5 centimeters). " > > > > > > > > Okay, now we leave the realm of medicine and enter > > the realm of > > analysis. > > > > NOTE: THE REMAINDER OF THIS POST IS MY OPINION, > > BASED ON THE > > RESEARCH LAID OUT ABOVE, ABOUT DEB'S SURGERY. I AM > > NOT A MEDICAL > > PROFESSIONAL, AND I HAVE ABSOLUTELY NO EXPERTISE > > WHATSOEVER IN > > MEDICINE OR ANY MEDICINE-RELATED FIELD. > > > > YOU MAY READ EXACTLY THE SAME SOURCES AND REACH > > DIAMETRICALLY OPPOSED > > CONCLUSIONS. IF YOU EXPLAIN YOUR REASONING TO ME > > NICELY, I WILL > > CONSIDER IT AND (POSSIBLY) CHANGE MY OWN VIEWS IN > > RESPONSE. BUT BE > > FOREWARNED, IN ORDER TO MAKE ME CHANGE MY VIEWS, YOU > > WILL FIRST HAVE > > TO DEMONSTRATE THAT YOU UNDERSTAND ALL OF THIS STUFF > > BETTER THAN I > > DO. > > > > > > Now then, with all those disclaimers in place, here > > is why I am > > troubled by Dr. Ren's report of her own actions > > during Deb's > > surgery. > > > > 1. Dr. Ren states that, " [t]he gastroduodenal > > artery was not > > visualized at any time. > > > > Given that, (according to Keet's article), the > > gastroduodenal artery > > supplies blood to the first portion of the duodenum, > > I would think > > that finding it prior to cutting anything would be > > rather important, > > so that one could avoid cutting it by accident. It > > seems > === message truncated === > > > __________________________________________________ > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 Hi, I'm not trying to make light of Deb's misfortune...but I've had discussions with doctors who told me about the (abeit few) patients they lost. If you can die from this surgery--or any surgery--why is everyone so shocked that there was a complication, and perhaps a bad choice of options in one person's surgery? I don't wish to throw lighter fluid on the fire here, but what makes this complication seem different, or worse, to everyone? Belinda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 I'm not trying to make light of Deb's misfortune...but I've had discussions with doctors who told me about the (abeit few) patients they lost. If you can die from this surgery--or any surgery--why is everyone so shocked that there was a complication, and perhaps a bad choice of options in one person's surgery? I don't wish to throw lighter fluid on the fire here, but what makes this complication seem different, or worse, to everyone? That is a very good point. Even the best in a field can have a bad experience doing surgery on patients. They are only human after all. We all go into the surgery knowing there is that chance of trouble. Not to say I don't feel for Deb. I do, and I wish her better health every day. It is disturbing to know things like this can happen, but its still rare and we all have to take the time to remember we have a choice before we go in to the OR. ~~* AJ *~~ BMI 59 INSURANCE: NW Washington Medical (Regence ) DR Heap, Richland WA Denied due to exclusion, denied appeal 6/7/01 going self pay - Dr Baltasar Spain Bellingham Support for WLS WWW.lookin2bthin.homestead.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 Belinda, Most likely because this is not a standard complication of DS or surgery in general. When Dr Gagner et al, Dr Hess and Dr Rabkin were asked, none of them had experienced this complication in all their years of practice. Since no one else experienced this ever, while I'm sure it was unintentional, it is more of a surgical error on the part on the surgeon. While no surgeon is perfect, that kind of drastic error is a definite concern when it completely reduces a person's quality of life to WORSE than before surgery. Granted, Deb is the exception, not the rule, as many people have had successful surgeries with Dr. Ren, but by no means should we ignore the exceptions because some of us feel better with blinders on! Anita Pre-op in Denver > Hi, > I'm not trying to make light of Deb's misfortune...but I've had > discussions with doctors who told me about the (abeit few) patients they > lost. If you can die from this surgery--or any surgery--why is everyone so > shocked that there was a complication, and perhaps a bad choice of options in > one person's surgery? > I don't wish to throw lighter fluid on the fire here, but what makes this > complication seem different, or worse, to everyone? > > Belinda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 Well.. 1) the surgeon never discussed any alternative surgery with the patient. If she was going to perform a different procedure, the patient should have been forewarned that it was a possibility. 2) The patient had a healthcare proxy in the hospital during the surgery. The purpose of this was to insure that no procedure was performed without theproxy making the patient's wishes known. The proxy was never utilized. 3) The surgeon was aware of the adhesions present in the duodenal region, and took no care to identify major blood supply before " bluntly dissecting " the adhesions. This is a serious boo-boo.. not a complication. 4) There are complications, and there are complications. This is the only documented case of its kind, so it obviously is not an acceptable & expected risk. I could go on, but I think the point has been made. hope that helps- Liane > Hi, > I'm not trying to make light of Deb's misfortune...but I've had > discussions with doctors who told me about the (abeit few) patients they > lost. If you can die from this surgery--or any surgery--why is everyone so > shocked that there was a complication, and perhaps a bad choice of options in > one person's surgery? > I don't wish to throw lighter fluid on the fire here, but what makes this > complication seem different, or worse, to everyone? > > Belinda Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 25, 2001 Report Share Posted June 25, 2001 i think we are all never going to agreee. why not just end this subject and let those who want to go to dr ren just meet her and ask her themselves what happened. i am not a dr and i really don't know what happened. i hate to see everyone getting into it when there are other things to discuss more positive..i hope this is not offensive to anyone. i just think it keeps going back and forth. cheryl Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2001 Report Share Posted June 26, 2001 "Anita" writes:"Since no one else experienced this ever, " Maybe you better talk to Dr Maquire about this since he has reported to one of his patients that everytime he has come across lack of blood supply to the duodenum he has had to go back in and do a revision or has had a leak so now he just excises the duodenum remnant if it does not pink up. Nick in Sage writes in regards to one hot subject: "If you have a problem caused by your surgery, I am truly sorry. However, please stick with science, not your bias." And then compromises his own advice with this statement: "that it may well not have been caused by a complication at all, rather, it appears that it is likely that it could have been avoided with the exercise of proper care.If that is, in fact, the case, it is not a complication at all. It is the result of a failure to deal appropriately with the technical aspects of the surgery itself.Sometimes there are complications. Those are problem enough without errors in judgment by professionals creating an even greater risk." We are not medical professionals. Let us wait for the medical professionals to decide if this was an error in judgment or a rare complication in this surgery. Until that day I wish that we would can the remarks about something we do not know anything about. IE: Deb had a complication that is under investigation. List the complication. When the investigation is over there is still going to be a group of people that will not accept it. Either way. writes: "Surely it was not just "one" case where the obvious problem was a surgical error?!?" I am so sad that Dr Ren is guilty without waiting for the investigation to conclude. I hope none of you are ever called for jury duty and make your decision on circumstantial evidence and heresy. I know that this message will not convince some people but I have to try to rationalize some of the statements. I am not attempting to ask that we not mention this subject. I just think that we need to be careful how we word our statements. If anything comes out of this subject at all I think it should be: Should the surgeon operate on the bowels first or the stomach. If the pylorus is not viable then transecting the stomach horizontal or vertical is then the question. But that is a debate to be had among the surgical world and not on this list. I have heard a lot of stuff from nurses on this list that is practical and I do not want to offend anyone and ask anyone not to use their knowledge to benefit pre-op and post-op's alike. I just wish that we were not so sure that our knowledge is superior to a surgeons or to the investigational board that is processing all the information regarding Deb's complication. Viauhttp://www.angelfire.com/on/wannabemagic/WLS.htmlSwitched 3/29/01 6/25/01: 256 (-60 lbs) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2001 Report Share Posted June 26, 2001 I must say, you people are really good about taking things out of context. I’m sure you all would make great Christian Bible Fundementalists. you know this is really not called for.... to make degoratory comments about a religious group. if you were making fun of another religion or minority group, it wouldn't be tolerated and this should not either!!! cheryl Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2001 Report Share Posted June 26, 2001 accepted......... cheryl Quote Link to comment Share on other sites More sharing options...
Guest guest Posted June 26, 2001 Report Share Posted June 26, 2001 someone <?> Wrote: > writes: > " Surely it was not just " one " case where the obvious problem was a surgical error?!? " >I am so sad that Dr Ren is guilty without waiting for the investigation to conclude. I hope none of you are ever called for jury duty and make your decision on >circumstantial evidence and heresy. I must say, you people are really good about taking things out of context. I’m sure you all would make great Christian Bible Fundementalists. As we’ve been beating this dead horse over and over, allow me to have the club for a moment. These comments were my opinion. They are not based on fact, merely conjecture from the evidence I have reviewed, thought about and formed an opinion about. Dr. Ren is guilty..but guilty only as being human and having the possibility of making a mistake. While I am not 100% sure this is the case I wish to cite that very possibility. It is unfortunatle and VERY FORGIVEABLE in my opinion that this Saintly (saintly is my opinion) Physician may have slipped with her scalpel a bit. This is very unfortunate and though I wish this were not one of the possibilities, it is and there is nothing that will take that away. I am not judge and jury nor do I claim to be. A lot of things went wrong..and just like automobile accidents, shit happens when several unfortunate events or factors come together at the same time. Thanks, --handing the club to the next in line and giving the horse one more swift kick for good measure as he walks away. Thank you all for your ear. Quote Link to comment Share on other sites More sharing options...
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