Tuesday night we brainstormed a list of questions, because Bob had an appointment with his plastic surgeon Wednesday morning and with his general surgeon in the afternoon. I went in both times, before this I just sat in the waiting room, but Bob wanted me to ask things and also hear the answers. The plastic surgery appointment was a regular one, but the general surgery appointment was more of a Q&A session, not a check up.

Both doctors are extremely nice, but the general surgeon is especially nice. I think he would probably have been better suited to being a GP, in terms of his personality. He brought a resident with him, and she said nothing, but I think she was probably there so she could see how to handle patient concerns.

We went down our list with each doctor - in some cases we had different questions for them, in others we asked the same things to each of them. It sounded to me as if the barrel stomach / pot belly outcome from this next surgery happens to almost everyone, at least to some degree, so Bob will very likely wind up with a larger waist than he has now, and it will be a permanent change in his body. This was the one area where the plastic surgeon did not seem especially concerned - he said Bob has a belly already and it seemed like he was thinking, "why would you care?" (I guess he doesn't understand that after losing so much weight, it is disturbing to learn that your waist will increase regardless of those efforts.) I am not sure he would have been as honest about this outcome if he didn't know that Bob had watched the surgery video on the internet.

Bob said he could understand the plastic surgeon's attitude, though. After sitting in the waiting room - there are only three types of people there: beautiful people getting boob jobs, face lifts, or botox, a couple of people who are there for some exotic serious surgery (like Bob) that the plastic surgeon specializes in, and then the majority: morbidly obese people who are getting lapbands or gastric bypasses, or having tummy tucks etc. to remove excess skin from bariatric surgery weight loss. So, Bob said the plastic surgeon probably is disgusted after having to deal with all those fat people who bring problems on themselves. [One bummer for Bob is that a lot of people assume he has had bariatric surgery, not that he lost weight on his own; or that his weight loss is the cause of his current problem. Both things are not true.]

He told Bob that he cannot give him a cosmetic navel - too much other stuff going on during this surgery.

He will probably use porcine (pig) mesh, since it is the strongest next to the synthetic. (This kind of freaks me out since I am such an animal rights person, but I am trying to keep my feelings to myself.) He will have three drains. He will likely still be infected, but with a biological mesh, the body can eliminate it.

We mentioned Bob's RA to the plastic surgeon. The general surgeon already knew about it, but we wanted to be sure the plastic surgeon was aware of it too. I asked if Bob's body might be rejecting the mesh because of it and also might reject the biological mesh for the same reason. The plastic surgeon wasn't aware of a connection - he said he didn't think so but I could see he made note of it. Probably will have a resident do some research on the subject.

The general surgeon visit was much more comforting. He told us that he doesn't want Bob to have this surgery, even more than Bob doesn't want to have it, but he sees no other way to clear the infection, the synthetic mesh has to come out. He said he can control the infection indefinitely with antibiotics, but Bob really can't stay on them forever and once they are stopped, the infection will flare. He said the mesh won't be grown in and will be easy to take out, because the infection prevents it being grown into his body, even after this long.

Bob will be in the hospital about a week, and will probably be out of work about 6 weeks, but the general surgeon said that Bob can work from home or even go in part-time as soon as he feels well enough - maybe 3-4 weeks after surgery. The same is true of driving - he said as soon as Bob feels well enough, he can drive - maybe as early as 2-3 weeks after surgery.

I really pushed on how many lifelong limitations Bob will have - I have thought what they have been saying is BS (that he will be able to resume a nearly normal life). I said, we really want to reduce the risk that he will have a recurrance (about 30 percent do). So, they were more honest - the plastic surgeon said no air conditioners, no refrigerators, in fact, no coolers full of ice. The general surgeon said 25 pounds will be his limit. So I guess my increased activity level will be a permanent part of my life - not a bad thing, actually, since I have always exercised my brain more than my body (one benefit for me has been a drop of about 10 pounds, to my college weight).

I also requested a private room for Bob's hospital stay. The general surgeon said he can ask, but not guarantee. This is something that I plan to really insist upon. If I don't get a guarantee from the hospital, Bob is going to ask the boss of his boss to contact his high level contact at the hospital. He had offered to get Bob a referral to a place like Presbyterian in NYC - which Bob isn't interested in - so this should be a piece of cake for him.

I told the general surgeon that I want to be kept better informed when Bob is in the recovery room, and he immediately said that this is my right and he agrees and will be sure that happens. (Last time I sat there in the dark for hours, wondering why it was taking so long, when he was throwing up, having blood pressure drops, etc.) I told him I am not the type of person to freak out so I need to know what is happening. I asked that the surgery be in the morning, and this he could not promise - but he said it will be during the day. Neither of us was happy with that, so Bob may contact the plastic surgeon (since it not definitely being in the morning may be his call, not the general surgeon's).

I asked how they are going to be sure that Bob doesn't get the complications (puking, blood loss) that he had last time. He said the pre-operative testing will help, and the anesthesiologist will be made aware, so they will reduce the chance - but can't guarantee it won't happen again. I guess Bob must just be very sensitive.

After all this, the general surgeon said "these are easy questions, are you saving the hard ones for last?" And we said, yes. Bob told him, I want you to put on your faculty hat while we discuss this. He whipped out the journal article that the Pakastani doctor wrote, and the email thread that he has had with him. The general surgeon took the article, said "oh, it's in English," looked it over. We could see he was surprised that we found it, and he was not familiar with it. Also, he was impressed with it - I think he suspected after speaking to Bob on the phone that it was some piece of crap from a nutjob on the internet, not a real peer-reviewed academic journal. He also seemed surprised that Bob had emailed the doctor, and that the doctor had responded.

He wasn't encouraging at all about being able to use the same approach - he said it isn't standard practice in the USA. He had questions about how the 13 patients are doing today, whether they still need to take antibiotics or have needed additional treatment (our impression from the Pakistani doctor is no.) He wasn't familiar with the antibiotic (it isn't approved by the FDA for use in the US) and he wondered if we do have something in the same class. I told him that it is widely used in Canada, Australia, Europe... and I guess Pakistan (both the general surgeon and the resident laughed when I added that, and then chuckled again when I said it is approved for veterinary use in the US, so I guess if our dog ever had a mesh infection he will be fine).

Bob explained that we learned there have been 51 adverse reactions to it (liver damage) and that in Europe, they have developed a genetic test to see if you can take it - apparently Northern Europeans are more susceptible to side effects, which would explain why it is more widely used in Pakistan and not available here. Anyway, he kept the journal article and Bob is going to forward to him the emails he received from the Pakistani doctor.

Something else the general surgeon told us is that he only has had 2 patients get a mesh infection. He said he really appreciates that Bob came back to him, because that doesn't usually happen. He said that he has seen many more than 2 with infections because when someone gets one, they generally change doctors. So he takes new patients who have infections, but had the original surgery done by someone else.

Bob said, hey people buy lottery tickets and expect to win, and the odds are much better of getting an infection than of winning the lottery. I think the general surgeon could tell that we are pretty skeptical, so he said, you can't have all the bad luck. This time it will go well, you will be swimming in your pool next summer.

Bob is pretty comfortable at this point. He is not happy about the pot belly thing, but he said he will work on accepting that and maybe he will have good luck and be one of the few who don't get it.

One good thing, they were having a Brooks Chicken BBQ at the hospital, so we took that as a sign. We got chickens for Thursday (Wednesday evening we went right from the general surgery appointment to Lark Street and ate out).

Later in the week, he got a call from the holistic doctor's office - the lab results on his drain effluent came back. So he has an appointment with them tomorrow.

We've entered the phase where we are having a good time and entertaining ourselves - since he is facing such an ordeal, and will be laid up for six weeks. Friday night we went to see a community theatre group's production of The Producers. And we are doing the restaurant circuit, even more than usual.