GI and Surgeon interaction

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aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 1/2/2012 11:01 AM (GMT -6)   
I was wondering how the GIs and Surgeons interact ... my current GI may recommend a surgeon I don't necessarily wish to go with. If I choose another surgeon, I guess I'll have to get my GI on board as well - so that they can all work together on my case?

My question is - do I have to necessarily tell my current GI that I want to talk to a few different surgeons or should I independently go and schedule some appointments with a few surgeons - since my insurance does allow me to do so.

(I wanted to talk to both types of surgeons - those who do only Nissens and those who do both TIFs and Nissens)

Thanks

bcfromfl
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Date Joined Nov 2011
Total Posts : 417
   Posted 1/2/2012 11:12 AM (GMT -6)   
The only reason why it might be important is if your insurance required a referral, and it doesn't seem like that's the case with yours. Just carry copies of all your tests, plus symptoms, etc., and see as many surgeons as you like.

If your GI has a big ego (I've learned that quite a few do), then he might be offended if you make choices independent of his recommendations. So be it...

The only other reason to have surgeon/GI interaction is if you are driving quite a distance to see a special surgeon. In that case, they coordinate with a local GI to have tests and follow-ups done so you don't have to keep driving several hours to have every detail attended to.

-Bruce

aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 1/2/2012 7:10 PM (GMT -6)   
Thanks Bruce.

I am kind of in a dilemma. There are surgeons locally here (in Boston at Boston Medical) who do this procedure. However, they are not marketing it as much as others in the other parts of the US who have websites, youtube video testimonials etc. Some in fact, seem to be dedicated to treating reflux only (at least their website gives that impression). So, I am not sure how to evaluate the skills of these surgeons.

So, my question is - other than "how many procedures have you done" .. what other metric can I use to compare and decide on choosing the surgeon (or choosing who to go talk to). This is for TIF only. For Nissen, it is easier as there are a few most people seem to go to around here.

bcfromfl
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Date Joined Nov 2011
Total Posts : 417
   Posted 1/2/2012 7:41 PM (GMT -6)   
I went through the same thing, myself. There is a general surgeon in the city near where I live, who recently took the training for the TIF and started doing those powerpoint presentations about the TIF that so many surgeons are doing...trying to drum up business for themselves. I went to hear the presentation, and was impressed by his credentials...~20 years as a GI surgeon...but only three or four actual TIF procedures. (I was impressed by the EndoGastric presentation as well, but if I were to see one of these presentations now, I would be a naysayer about some of the details. Anway...) Based upon the fact that he had a lot of experience as a surgeon, and the fact that it doesn't take a tremendous amount of skill to perform the procedure (the EsophyX device does most of the work), I tried to set up an appointment with him. He wanted to see my charts first, which I brought to him, and he said he wasn't interested in helping me because of my eosinophilic esophagitis. I think he was only interested in garnering a lot of successful procedures, and not willing to take on complications, even though the EoE is treatable.

So, I actually found a better surgeon three hours away, and was willing to take on my case. He had only done seven TIFs, though, but again, I wasn't too concerned because of his other experience and credentials. He also does the Nissen, so it was good to speak with someone with an intimate understanding of both procedures.

I think you probably have a good selection of qualified surgeons in Boston who can do the TIF. I wouldn't be influenced by all those websites and YouTube videos -- other than to use them for informative purposes. I would look for surgeons who also do the Nissen. I think that's the most important qualifier for someone who would do a good job with the TIF.

If you notice on the EndoGastric website, they "rate" qualified surgeons by Gold and Platinum designations. This has to do with how many procedures they've done. If you open up your driving range to NYC, there are a handful of Platinum surgeons there. Given the population of the Greater NY area, you can be certain that they've done a ton of them.

Good luck!

-Bruce

aciphexo
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Date Joined Apr 2011
Total Posts : 377
   Posted 1/2/2012 8:09 PM (GMT -6)   
Thanks again Bruce.

I didn't know that you were also dx'd with EoE. So, in your case - you have EoE as well as LPR/GERD? So, was EoE dx'd by inspection or with the biopsy? In the 2 endoscopies that I've got, they haven't done a biopsy to look for EoE - I assume they look for the rings in the esophagus first .. and if they show up then they do the biopsy to confirm? So, based on your case - even if someone has LPR/GERD - it does not mean that they can not also have EoE.

bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 417
   Posted 1/2/2012 8:37 PM (GMT -6)   
In my endoscopy I had in Feb 2011, I had the rings, and the biopsies confirmed. Up to 14 eosinophils per HPF. The GI immediately put me on a daily regimen of Pulmicort, and backed it off to once per week, four weeks later. The biopsies taken during my July 2011 endoscopy showed <5 eosinophils per HPF, and no rings.

After the TIF procedure in August, I started backing off the Pulmicort thinking that, since the eosinophils were a response to the reflux, and that the reflux is "now gone", the inhaler should no longer be necessary. I gradually got sicker and sicker, noticed a burning near the LES, started running a fever, lost my appetite, and had a general feeling of malaise. Had another endoscopy (and the pH study) in October, and the biopsies showed up to 14 eosinophils per HPF -- but no rings. Two doses later of Pulmicort over the course of the next week and I felt 10 times better -- and the heartburn-like pain has never reappeared.

So, in my case, I think it's pretty clear that the eosinophils are a response to reflux, and not food allergy. I'm not aware of any allergies, anyway. What's also clear is that in two separate biopsies, with two identical eosinophil counts, one had evidence of rings and the other one didn't. I think the rings would have reappeared if the condition had continued after October.

EoE isn't considered acute until you reach about 20 per HPF, but numbers greater than 10 are consistent with reflux, and can cause significant issues. You can't depend upon only a visual inspection to determine whether it's present or not -- it has to be a biopsy.

Yes, I have both the EoE and LPR...lucky me! ;-)

-Bruce

aciphexo
Regular Member


Date Joined Apr 2011
Total Posts : 377
   Posted 1/2/2012 8:58 PM (GMT -6)   
I see. I didn't know that EoE can be a response to reflux. Plus, I've heard that the dysphagia is the most common symptom of EoE. Did you have that as well?

bcfromfl
Regular Member


Date Joined Nov 2011
Total Posts : 417
   Posted 1/2/2012 10:13 PM (GMT -6)   
Yes, although the dysphagia in my case...I think...is more directly because of the reflux. That because the dysphagia persists even with a low eosinophil count.

-Bruce
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