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What kind of doctor do I see for this?


Kassia
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I had an intestinal obstruction a few weeks ago that was resolved without surgery.  From what I've read there is a high chance of recurrence.  Financially, and for convenience, it makes sense for me to have surgery to prevent the obstruction from happening again since I will have met my out of pocket deductible and I am constantly worrying about when/where it will happen again.  

 

I made an appointment with a gastroenterologist to discuss possible surgery.  But now I'm thinking that might be the wrong thing to do since I don't think he would actually perform the surgery.  Would I make an appointment with a general surgeon (that's who took care of me in the hospital)?  I don't even know if that's possible...I've never needed a general surgeon before.

 

 

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It really depends on what caused the first obstruction. If it was caused by a physical abnormailty that was medically diagnosed at that time and is still present a general surgeon might consider treating you as a follow-up patient with a pre-existing issue. However, if the problem wasn't caused by physical abnormality, or if the abnormality is no longer present, you're going to need a gastroenterologist to say that you require surgery in order to get a surgeon on board. Also if your gastroenterologist doesn't think you require surgery right now your insurance may not cover it, paid up deductible or not.

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It really depends on what caused the first obstruction. If it was caused by a physical abnormailty that was medically diagnosed at that time and is still present a general surgeon might consider treating you as a follow-up patient with a pre-existing issue. However, if the problem wasn't caused by physical abnormality, or if the abnormality is no longer present, you're going to need a gastroenterologist to say that you require surgery in order to get a surgeon on board. Also if your gastroenterologist doesn't think you require surgery right now your insurance may not cover it, paid up deductible or not.

 

Thank you!  It sounds like the gastroenterologist is the correct first step then.  

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Until recently, we had a Gastroenterologist who lived down our street.  I think that is a sub specialty of Internal Medicine, like Cardiology?  I am not sure if they do surgery, however, if I had a Gastro Intestinal problem, I would begin with a Gastroenterologist.

 

For example, if someone had a Cardiac problem and they went to a Cardiologist and the need for  surgery was indicated, the Cardiologist would send them to a Cardiac Surgeon.  I think Internal Medicine doctors are non-invasive, but possibly they do surgery too?  

 

I would not go directly to a surgeon unless I was positive that I had a problem that required surgery.

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Then you need to go back to the surgeon. But, make sure you understand that the surgery itself can increase your chance of future obstructions (and other complications). The surgeon should educate you on the risks of obstruction with your particular abnormality verse the risk of obstruction secondary to the surgery.

Edited by Minniewannabe
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I do not know what caused the obstruction but I do know someone who deals with this from time to time because he had surgery in the intestines where some was removed. He ended up with infections and scarring and they do not want to have to operate on the area again even when he has an obstruction.

Edited by MistyMountain
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Both, possibly.  The surgeon can look at a cat scan and see if she/he needs to use mesh to reinforce a weak part of the abdominal wall or remove any kinked bowel - a cat scan could also show if there is a narrowing of the colon that the gastro doc could enlarge (I forget the term) from the inside.

 

I had to go to ER with abdominal pain that wasn't going away end of May, spent one night with a NG tube (hate those things) as the obstruction subsided for the time being. Went in for what we thought would be minor hernia repair (this had happened at the site of previous surgery) and ended up spending five more days as surgeon, once she got in there, found adhesions mangling several inches of the small intestine, which was also kinking, she had to remove the bad bit and reconnect the rest.  

 

A few days later I had to go back as everything stopped working AGAIN and needed that dang NG tube (did I mention I HATE those with the passion of a thousand burning suns?) for four days. I had gone home with instructions to go low fiber, but had eaten too much apparently.

 

Now I am home (again) for six weeks of extremely low fiber, soft food diet - sweet corn is in and I can't have any!!!!!! nor any of the chard/kale/carrots/tomatoes in my backyard :-(  as bowel needs time to recover before gastro doc does his thing - in effect Roto Rootering out my colon since I have a restriction in it at the site where it had been put back together three years ago after a car crash.

 

In your case, I'd start with the gastro doc.  It may be something he/she can take care of as part of a colonoscopy.   Meanwhile - Phillips Milk of Mag. comes in pills now, one or two a day to keep things moving is a good idea.

 

Meanwhile, I have only had Ritz crackers and water the past six hours as no matter what I eat I get gas now. Not fair!!!!

 

Anyway, you have my sympathy. Bowel troubles are NO FUN!!!!!!!!!!!!!!!!!!!!!

 

My general surgeon is a hoot - first used her when dd needed a wonky gall bladder out as a teen.  So when time came post-car crash to put my innards back together, I called her.  Find a surgeon you trust and like, never know when you may need them again for something or other.

Edited by JFSinIL
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Both, possibly.  The surgeon can look at a cat scan and see if she/he needs to use mesh to reinforce a weak part of the abdominal wall or remove any kinked bowel - a cat scan could also show if there is a narrowing of the colon that the gastro doc could enlarge (I forget the term) from the inside.

 

I had to go to ER with abdominal pain that wasn't going away end of May, spent one night with a NG tube (hate those things) as the obstruction subsided for the time being. Went in for what we thought would be minor hernia repair (this had happened at the site of previous surgery) and ended up spending five more days as surgeon, once she got in there, found adhesions mangling several inches of the small intestine, which was also kinking, she had to remove the bad bit and reconnect the rest.  

 

A few days later I had to go back as everything stopped working AGAIN and needed that dang NG tube (did I mention I HATE those with the passion of a thousand burning suns?) for four days. I had gone home with instructions to go low fiber, but had eaten too much apparently.

 

Now I am home (again) for six weeks of extremely low fiber, soft food diet - sweet corn is in and I can't have any!!!!!! nor any of the chard/kale/carrots/tomatoes in my backyard :-(  as bowel needs time to recover before gastro doc does his thing - in effect Roto Rootering out my colon since I have a restriction in it at the site where it had been put back together three years ago after a car crash.

 

In your case, I'd start with the gastro doc.  It may be something he/she can take care of as part of a colonoscopy.   Meanwhile - Phillips Milk of Mag. comes in pills now, one or two a day to keep things moving is a good idea.

 

Meanwhile, I have only had Ritz crackers and water the past six hours as no matter what I eat I get gas now. Not fair!!!!

 

Anyway, you have my sympathy. Bowel troubles are NO FUN!!!!!!!!!!!!!!!!!!!!!

 

My general surgeon is a hoot - first used her when dd needed a wonky gall bladder out as a teen.  So when time came post-car crash to put my innards back together, I called her.  Find a surgeon you trust and like, never know when you may need them again for something or other.

 

Oh, I'm so sorry for everything you've been through and are going through now!  

 

I totally understand about the NG tube.  I had one during my hospital stay and it was absolutely awful.  I was like a different person when they took it out because I was so relieved and happy to be free of it!  I ate ice chips nonstop because I constantly felt like gagging from that awful tube.  And I couldn't talk at all.  I told DH and my kids not to visit me because I couldn't talk and was so miserable.  

 

I had a total obstruction - both large and small intestines were involved but, after a lot of going back and forth about emergency surgery,  they were able to fix it with a sigmoidectomy.  I was in agony from the pain before the procedure.  From what I've read, there's a high chance of recurrence unless I have a resection where they shorten the large intestine so it can't twist again.  I felt like I was having a problem a few weeks ago (of course, when I was out of town) and was really scared, but have been ok since then.  I just hate not knowing if/when/where it's going to happen again.  And, with a high deductible, I can't afford to go through this again if I can prevent it with surgery.  

 

Thanks for sharing your experience.  And, again, I'm sorry for what you have been through and are going through!  

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I learned that not just ice chips, but there is a suction doohicky you can use (if nurse isn't quick enough) to relieve the gagging feeling.  It does sound like you will need surgery :-(     Stupid innards, ruining folk's summer.   I need to plan to fly to California in Sept for my Dad's memorial (he passed July 4th) but don't want to do anything until I am sure I am absolutely safe to travel w/o innards acting up. 

Edited by JFSinIL
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I learned that not just ice chips, but there is a suction doohicky you can use (if nurse isn't quick enough) to relieve the gagging feeling.  It does sound like you will need surgery :-(     Stupid innards, ruining folk's summer.   I need to plan to fly to California in Sept for my Dad's memorial (he passed July 4th) but don't want to do anything until I am sure I am absolutely safe to travel w/o innards acting up. 

 

Thanks!  One nurse got Chloraseptic spray for me, but I didn't think it would help so I didn't use it.  The ice chips helped a lot.  

 

I'm sorry about your dad.  It is scary to travel not knowing if something is going to happen.  When I was in the hospital, I kept thinking how grateful I was that I was home when the obstruction occurred and not out of town or especially out of the country (we went to the Dominican Republic a few months ago for vacation).  

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Oh, one more thing about the NG tube.  When my surgeon placed the order to have it removed, the nurse didn't do it right away.  When he saw that I still had it in, he went over to her and asked her if she had ever had one.  When she said no, he told her that was the reason why she hadn't taken it out yet and scolded her for leaving it in.  I was embarrassed about it, but grateful because she removed it a few minutes later.  

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My doc was surprised it had not been removed when she came to see me last week - I reminded her that no one wants to risk getting in trouble removing it w/o doc orders to do so - the only reason I had not myself removed it was I knew they would have shoved it back in (the only thing worse than coming out of anesthesia and finding that , crap, there is an ng tube is having one inserted while you are awake.)  Then while she took her time getting gloves on - I removed the ng tube.  Gosh, that felt good. And I made my surgeon laugh (she is just younger enough I can give her a hard - yet humorous - time.  She says I crack her up).

 

Had already watched and learned how to turn off and disconnect the ng tube from the wall suction thingie so I could get to the bathroom (then i reconnect it).  I can push most buttons and reset a beeping iv machine too now. Every stay I pick up more info.  Staff knows me from too many visits the past three years now, I am a "low maintenance" patient.  Haven't figured out how to insert my own iv yet - bet I could on someone else, though, now.

Edited by JFSinIL
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If I have to go back, I want you as my roommate!   :001_smile:

 

I figured out how to reset the IV machine pretty quickly since it kept going off for some reason.  And I learned how to disconnect everything so I could use the bathroom (that took forever!).  Do you have the leg compression sleeves, too?  I try to be a low maintenance patient.  We were just discussing that last night - how it feels wrong to bother the nurses for things like ice chips and they need someone on staff to fulfill nonmedical needs.  

 

My ng tube was inserted while I was knocked out.  I think I would refuse it if it had to be inserted while I was awake!  I can't even imagine how horrible that would be.  I was told they had a really tough time inserting mine and there was some controversy over whether it was down far enough.  

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