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Kings College Hospital London/Guys Hospital outcome letter. Confused & worried

Discussion in 'General Surgical Weight Loss Discussion' started by L Marcelle, Nov 12, 2017.

  1. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    Hi everyone. I'm hoping someone could help me as im a bit worried.

    I was refered by my GP to St Thomas in February 2017.

    I was seen at St Thomas' Hospital for a group barriatric educational meeting in April 2017.

    Then in June 2017 I was seen at Guys Hospital Medical Obesity Clinic where i was seen by a dietician who spoke to me about food, weight problems etc, a dr who took all my medical history and bloods were taken and i was weighed.

    I was told i would be discussed at the MDM Meeting after my sleep Apneoa test i was doing at another hospital in October.

    Today I received a letter following the mdt discussion that the drs etc had about me at Guys Hospital in October.

    It mentioned the following -

    Bmi - 52.4
    HAD - 17
    ES - 16

    Problems/diagnosis:
    Hypothyroidism
    Sarcoidosis
    PCOS
    Sleep Apnoea - commenced of CPAP October 2017
    Osteoarthritis

    They then listed the medication i was on.

    No tier 3 required
    No dietetic assessment contraindications
    Physiciatry - no assessment required
    Cardiovascular investigations - No assessment required
    Oximetry: On CPAP

    MDM Outcome

    This patient was discussed at out MDM meeting today.

    MDM Outcome:

    We will refer the patient to Kings College Hospital for consideration for bariatric surgery.

    I know all Guys & St Thomas' patients get refered to Kings College hospital after tests have been done at Guys Hospital.

    My question is what do they mean by consideration? Could i still be refused? Also could they override what Guys Hospital said about me not needing to do tier 3?

    Any information will be very much appreciated.

    Thank You
     
  2. SAM55

    SAM55 Well-Known Member

    Posts:
    1,854
    Likes Received:
    1,332
    Start Weight:
    25st2.7lb
    Current Weight:
    17st3.2lb
    Goal Weight:
    14st13.4lb
    Lost(%):
    7st13.5lb(31.61%)
    Surgery Type:
    Sleeve
    Funding Type:
    NHS
    Consultant:
    Mr Mehta
    Surgery Date::
    5th September 2016
    I am guessing that the consideration is because you haven’t seen the surgeon yet? They will want to discuss with you the different surgery options and check you over from their point of view. Have you researched and thought about which procedure you are interested in?
     
  3. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    Hi, thanks for your response. I hope thats what they mean when they say consideration.
    I have done lots of research and would like to have the bypass. Its something i mentioned to the dietitian at the first Guys hospital appointment.
     
    SAM55 likes this.
  4. TiaLi

    TiaLi Active Member

    Posts:
    339
    Likes Received:
    225
    Surgery Type:
    Gastric Bypass
    Funding Type:
    NHS
    Consultant:
    Prof Ameet Patel
    Surgery Date::
    14 March 2017
    I wouldn't get too hung up on the "consideration" phrasing - until your surgeon has given the final go-ahead and you are on the actual waiting list, it's only natural to use that terminology. Be prepared that the wait at King's is quite long, and be prepared that the "18 weeks" they tell you once you are on the actual list is only the guidelines they are aiming for and not a reflection of reality.

    Do you know which surgeon you will be under? Chang and Patel do things slightly differently. I believe there's also a third bariatric surgeon at King's now, but can't remember his name. I had a bypass under Professor Patel.
     
  5. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    Thanks for your response.
    We were given a pack at the first group meeting at St Thomas' where we were told about the different types of surgeries.

    In the pack it had information about waiting times.

    It mentioned after the MDM meeting at Guys there is a 4 week wait before you get an appointment to meet the surgeon at Kings College Hospital. You are then put on the waiting list for surgery this will take about 7 months then there will be the pre-op, post-op diet group discussion. 6 weeks after that should be the surgery.

    So i know it may take 8 months after meeting the surgeon before the op.

    I have no idea about which surgeon i will be seeing. I'm not sure if I will have the option in choosing a surgeon. If I do have a choice i have no idea who i will go with.
     
  6. TiaLi

    TiaLi Active Member

    Posts:
    339
    Likes Received:
    225
    Surgery Type:
    Gastric Bypass
    Funding Type:
    NHS
    Consultant:
    Prof Ameet Patel
    Surgery Date::
    14 March 2017
    I think you can request a particular surgeon if you want to (I was told by the dietitian I could swap if I wanted at least). But if you don't have your heart set on a particular surgeon just go with whoever they give you. I had Prof Patel and he was amazing - VERY thorough surgeon who is also super nice and genuinely cares about his patients. I think his waiting list tends to be a bit longer though since he is in high demand. I've heard great things about Avril Chang as well though, and I believe there are quite a few people on this forum who have had her. I know nothing at all about the newer one - but he might be great as well (not so new anymore either, but he had just started at King's when I was put on the waiting list).

    The one hiccup I had was with one of the nurses (there are two) who managed to add about a year to my waiting time by messing up my papers. But that's obviously (well, hopefully) unusual.

    Prof Patel doesn't do the liver shrinking diet with his patients but Chang does. The order they gave you in that pack in terms of appointments might differ as well - at my pre-op/post-op diet group meeting with the dietitians I had already had my meeting with the surgeon, but there were several people who hadn't. So don't get worried or confused if things aren't in the order you think it will be - sometimes they need to rejig for efficiency purposes.
     
  7. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    Thank you for all that information. It's very appreciated.

    I have heard of the liver shrinking diet. I don't mind if I have to do it. If all surgeons have good reputations and I have a choice of surgeon i may just go with the one who has the shortest waiting list.

    Were you also seen at Guys Hospital first?
     
  8. TiaLi

    TiaLi Active Member

    Posts:
    339
    Likes Received:
    225
    Surgery Type:
    Gastric Bypass
    Funding Type:
    NHS
    Consultant:
    Prof Ameet Patel
    Surgery Date::
    14 March 2017
    No, for the surgical pathway I was referred straight to King's, so I'm not entirely sure how many (if any) tests you'll need to repeat I'm afraid. The tier 3 at King's is a couple of meetings with the dietitians over a period, but unlike many other hospitals they don't put weight loss requirements on their patients during tier 3. So for me the order was:

    * First meeting with the bariatric nurse.
    * Sleep apnoea/lung function test
    * Tier 3 meetings with dietitians
    * Meeting with Prof Patel - got put on the waiting list.
    * Group meeting with dietitians (the pre-op/post-op diet info meeting)
    * Pre-op assessment
    * Surgery

    I had my bypass on March 14 2017 - so I'm exactly 8 months out today. Since surgery I've had regular catchups with the dietitians every 3 months (when they also do bloods) and one meeting with the surgical team (I was also readmitted to hospital for two nights 2 months out, so technically I've had two checkups with them). I'll be having my second/third checkup with them in January. I've lost 10 stone since surgery (11 stone since the pre-op assessment).
     
    SAM55 likes this.
  9. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018

    Wow, congratulations on the weight loss. You must be feeling fantastic.

    Hopefully I won't have to redo any tests. I just have to try to be patient and wait for my appointment to find out what the next steps are for me.

    Thanks for all your responses.
     
  10. TiaLi

    TiaLi Active Member

    Posts:
    339
    Likes Received:
    225
    Surgery Type:
    Gastric Bypass
    Funding Type:
    NHS
    Consultant:
    Prof Ameet Patel
    Surgery Date::
    14 March 2017
    Thank you. Yes, it's definitely greatly improved my health and quality of life.

    If you have any other questions just give me a shout - good luck with everything!
     
  11. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    I will do. Thank you
     
  12. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    Hi, I've just received a letter for an appointment at Kings College Hospital at the general surgery clinic with Professor Francesco Rubino at the Golden Jubilee Wing.

    Do you know what this appointment may be about? Is this the other surgeon at Kings?
     
  13. TiaLi

    TiaLi Active Member

    Posts:
    339
    Likes Received:
    225
    Surgery Type:
    Gastric Bypass
    Funding Type:
    NHS
    Consultant:
    Prof Ameet Patel
    Surgery Date::
    14 March 2017
    Yes, I believe that is him, the name rings a bell. Be prepared that the appointment might not be with the surgeon itself but with one of his staff (i.e. anyone else in the team such as a bariatric nurse). They will list the name of who is responsible for the clinic (i.e. the surgeon) but it doesn't necessarily mean it is with him.

    It could be of course - like I say, not entirely sure how the pathway differs when you come in via Guy's & St Thomas. But I remember my first appointment said it was Prof Patel but ended up being with his nurse. I didn't get to see him until much later.
     
  14. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    Ok. Thanks. What usually happens in this appointment?
     
  15. TiaLi

    TiaLi Active Member

    Posts:
    339
    Likes Received:
    225
    Surgery Type:
    Gastric Bypass
    Funding Type:
    NHS
    Consultant:
    Prof Ameet Patel
    Surgery Date::
    14 March 2017
    My first appointment with the bariatric nurse was basically just talking through my medical history etc and get me "signed in". So that was over pretty quickly.

    For the actual meeting with the surgeon (which was much later), the appointment started out with a meeting with his nurse (different one from the first since I refused to deal with her anymore after she messed up my papers). She talked me through all the surgical options and asked me if I had thought about which one I wanted etc. I then got to see Professor Patel and discuss with him. After this I was put on the actual waiting list.
     
  16. TiaLi

    TiaLi Active Member

    Posts:
    339
    Likes Received:
    225
    Surgery Type:
    Gastric Bypass
    Funding Type:
    NHS
    Consultant:
    Prof Ameet Patel
    Surgery Date::
    14 March 2017
    I should stress, however, that all surgeons have their own style so things may well differ between them even in terms of what happens at the various appointments. Like I said earlier - Chang for example sticks to the LRD before surgery whereas Prof Patel doesn't like his patients to do that. Not sure where Rubino stands on the matter.

    ...I would advise you to just ask them at your appointment what happens next, what you can expect etc to be on the safe side. They are not always very good at telling you without prompting, so it can be a bit confusing. I always wrote down all my questions before each meeting to ensure I didn't forget anything.
     
    Last edited: Nov 16, 2017
  17. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    I think i'll need to write down questions to ask too. I done a little research on here on that surgeon. People only have great things to say about it. I hope the next 9 weeks fly by.
    You've been such a great help in answering all my questions. Thank you ☺
     
  18. TiaLi

    TiaLi Active Member

    Posts:
    339
    Likes Received:
    225
    Surgery Type:
    Gastric Bypass
    Funding Type:
    NHS
    Consultant:
    Prof Ameet Patel
    Surgery Date::
    14 March 2017
    No worries at all happy to help - I know when I went into this process I was sooooo nervous and it really helped knowing what to expect. If you want a more detailed account of what happens at the pre-op and actual day of surgery you can find that in my diary ( https://www.wlsurgery.com/threads/time-for-change-tialis-diary.161655/page-4 ) stopped posting in it pretty soon after my surgery so it's not very up-to-date but it might be helpful if you want to know what to expect on the actual day.
     
  19. Maria61

    Maria61 Well-Known Member

    Posts:
    1,998
    Likes Received:
    3,659
    Start Weight:
    19st7lb
    Current Weight:
    11st4.3lb
    Goal Weight:
    11st0lb
    Lost(%):
    8st2.7lb(42.01%)
    Surgery Type:
    Gastric bypass
    Funding Type:
    NHS
    Consultant:
    Mr Jain Luton and Dunstable
    Surgery Date::
    19th September 2017
    Good luck to you x
     
  20. L Marcelle

    L Marcelle New Member

    Posts:
    27
    Likes Received:
    1
    Start Weight:
    22st5.7lb
    Goal Weight:
    9st1.9lb
    Surgery Type:
    Bypass
    Funding Type:
    Private
    Surgery Date::
    26th April 2018
    Thank you
     
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