Response Dr. H

[Guest guest]

Sorry everyone I tried to send this 3 times lets hope it works now!

Dear Dr. Spigland and Mrs. ,

I did speak with Dr. Vanoker after forcing him to call me back. According

to the GI people there, he is the Chief of Peds Surgery. He apparently is all

business and a hard worker. Mrs. , your feeling about him as to

whether he will actually work with us will be better than mine. I do know that

when children are admitted for surgery there, they are on the surgical service,

not the pediatric or the GI service. That is the same as it is at Cornell

which was always a problem with all the pediatric surgeons until Dr. Spigland

came into the picture.

I have changed my mind as to the surgery that she should have. Instead of

having a long J tube placed, I want a loop of the proximal jejunum brought up

to the skin, fix it in place and then a MicKey button placed instead of a

long J tube. I guess the surgery could be done in stages, but there is no

question in my mind that she will need a tightening of her Nissen for her to

begin

to take in enough kcals orally to wean off the non-volitional feeding. This

is necessary to prevent the severe reflux that periodically results in the

periods of vomiting and dehydration. She will also need the gastric button

placed up higher in the stomach to prevent its obstructing the stomach.

I agree with you, Dr. Spigland, that it would be easier for the family if

she were closer to home, but the most important issues are the surgical

abilities and the listening and learning abilities of the surgeon. Of course,

I

would rather you do the surgery, Dr. Spigland . I understand your reservations

because I will not physically be there and the GI service at Cornell is no

longer good. None-the-less, personally, I would rather have both procedures

done at one time. I would rather Miles Diner do the anesthesia. I think after

Sx she should be sent to the Cornell PICU where you, Dr. Greenwald and I, on

the phone, can manage her acute post operative course. I would then suggest

transferring her from the Cornell PICU here to MSSM so that I could manage

her with phone help from you, Dr. Spigland.

If that is not acceptable to you, Dr. Spigland, then we must get Kathy Chen

to help us decide which of their surgeon to use and make 100 % sure that that

surgeon agrees that her fluid and calorie management will be the

responsibility of Drs.Chen [GI] and Suarez, [Endo] with careful help from me.

Dr. H