Persistent abdominal pain 3 1/2 years post GBP: can't find adequate care.

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     I am in quite a perdicament and any suggestions/advice would be sincerely appreciated.


     By factualy background, I had gastric bypass in August 2011. It was an overall extremely successful, uneventful experience without any notable complications. In February 2014, I suffered an internal hernia and acute bowel obstruction. I underwent surgical repair which went great and again there were no notable issues or complications. I have recently began to experiencing some abdominal pain, constipation and painful gas and BMs. (This pain is in the same area of the hernia surgery.) Over the last few months, this pain was mild to moderate in nature (I would call it more of an uncomfortable sensation instead of "pain.") However, I had an episode of this abdominal discomfort last Saturday that was severe in pain followed by a very painful bowel movement. The pain has been chronic and severe since. The pain is so bad I cannot work, can't walk or stand for prolonged periods of time. I cannot eat at all. I can drink but it hurts . I have not had a bowel movement since last Saturday when thia all started.


     I went to the ER on Sunday (the day after the pain began.) They did an ultrasound and I was discharged with the recommedation to take the CT scan - which they deemed to be abnormal but it did not show a concerning blockage or obstruction - to my bypass doctor.


     Issue: My insurance does not have a single gastric bypass surgeon in network -- not one! I saw a general surgeon who specializes in hernia repair, ulcers repairs, colon/rectal surgery, etc on Wedensday. He would not do any work-ups on me b/c he does not specialize in gastric bypass. He sympathised with my situation and tried to help me find a doctor who would help bu we cannot find anyone. He put me on ulcer meds, high potency probiotics, proton pump inhibitors and a prescription for h. pylori. After speaking with him again yesterday, he advised me to go to ER again b/c he is concerned I may have bloackage. I went to ER and they did an X-ray. They discharged me saying I have compacted stool all the way to my stomach which is why I cannot eat anything. They recommended I drink Miralax and follow-up with my bypass surgeon by Monday and if I haven't had a BM by Monday, to return to ER.


     I do not know what to do. I cannot find a bypass doctor who will help me. Regular gastroenterologists have denied treating me. I haven't eaten since last Saturday. Drinking is extremely painful but I am forcing fluids. I don't know what to do but I need help. The ER just sends me home. I am at a complete loss and would truly appreciate advice. I am hoping the pain is from the constipation and possible ulcer but I know it could be something much worse.



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Dear DeeDee,


As I read your post, you have two problems. The first is abdominal pain of unclear origin, and the second is a systems problem: you can't find a physician to treat you because you are a "gastric bypass patient". I can't give you personal medical advice. I do think you are doing the right thing. Your are being persistent and conscientious by going back to the ER because you are not improving. Any good general surgeon and any good gastroenterologist should be able to help you. There is very little difference between a gastric bypass and a partial gastrectomy other than the bypassed portion of the stomach is left in place with gastric bypass. Having said that, there are some surgeons and some gastroenterologists that duck the care they should provide. (Never assume malice until you rule out ignorance ... or laziness.) If a surgeon or gastroenterologist feels insecure about how to proceed, he or she can always call a bariatric surgeon and ask for advice.


If you go to your local hospital, and if you need acute care that isn't available locally, you should be transferred to a center that can provide the care. It would be prudent for you to call your insurance company at the time to inform them. If you are an outpatient and can't find local care, call your insurance company and ask them how to proceed. They have the responsibility to see that there is an adequate network of qualified physicians to care for their insured. 


If you are having trouble getting the care you need at your local hospital, you can contact the chief of the medical staff, the medical director of the hospital, or the chief administrator of the hospital. If your insurance company is not helpful, you can contact your state's  insurance commissioner or department of managed care. 


Your situation finding a qualified and caring doctor is not unique. The federal government is forcing rapid change on the healthcare system in the name of cost containment. As we go from a fee for service model where at times too many services were provided, we are moving to a rationing system where good care will be less accessible and less timely. I encourage you to stick up for yourself and insist on proper care.


Dr. Callery

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