OT-collecting pee and any ideas for talking to a cocky surgeon?

I just had to share that my GI has had this idea of having me tested for prophyria, so I have to collect my urine for 24 hours. what a hassle! also, I will see my surgeon in a week to discuss surgery again. I went to this guy a year ago and he cut my colon away from the inside wall of me by cutting the adhesions. It appears the adhesions were never all cut and probably some has come back. I am trying to decide how to deal with the surgeon. he is younger than me and the hotshot of our town...the surgeon all the docs say is the man. however, when I met with him last year he kept saying "first I have to decide if you are crazy," and "well, you don't seem to be crazy," etc. Now I am a middle aged, professional, bright woman--it feels quite insulting to be talked to like that. any ideas of how to stop him without insulting him?

thanks, yp

I deal with all specialties of physicians because of my job, and general surgeons tend to be the most arrogant of the lot. Not all surgeons, of course, are arrogant, but in my experience, they are the ones I have the hardest time getting a hold of and are the most difficult to communicate with. I find the best way to deal with them is to be knowledgeable, prepared and understanding of their stressful and time intensive profession. So when you speak with your hot shot surgeon, have all your questions prepared and keep asking them, until your questions are answered. He may have one hand on the door knob, which is kind of intimidating, but don't relent. If I don't have a cheat cheat with my questions written down, I get intimidated by the physician's impatience, and forget what I wanted to ask. So just be prepared and don't be intimidated. If you feel he's insulting you, I'd tell him. Surgeons may be arrogant, but they're also very honest. They see things black and white (I know I'm way overgeneralizing here, but I'm just speaking from my experience), so it's better to let him know if you think he's off base, and he'll probably respect you for that. Good luck!

I can't stand these type of docs, I'm in school with a bunch of surgical wannabes who sound exactly like this guy.  And you know what I say to them?  I say, "You might be a wonderful surgeon one day.  It's really too bad that you won't have any patients because you're such an egomaniacal jerk." Jeez louise.  I don't think I've actually said that, but I wouldn't put it past me.

Anyway, if the guy's a great surgeon and just a stupid person, you might want to keep him as a surgeon but write him a letter.  Say, "You know, I think you're a great surgeon, I'm sure you had a 4.0 in medical school and you did your first appendectomy when you were 12.  As much as I appreciate your knowledge, I do believe you could benefit tremendously from some improved patient interaction skills.  I was deeply offended by your comments X, Y, Z and hope that you can understand why such comments were inappropriate." Be nice and gracious and the bigger person in your letter, but don't let him get away with that kind of behavior.

If he does not respond or bring it up at your next visit, you should think twice about this guy. 

BTW, they should have checked you for porphyria long ago!  Who are these lame-os?  If you have any questions about porphyria, let me know, I spent about 293847 hours trying to understand the various forms of it.

Yogaprof,

Yeah, 24 hour urines are really fun aren't they? The container they gave me had an opening about the size of a mens urinal. I ended up using one of those throw away type tupperware's that fit perfectly on top of my toilet seat, and then poured it in the container they gave me. I kept it in paper bag in my refrigerator because it grossed me out looking at it in there, lol.

I'm not sure what prophyria is even after looking it up, but I sure hope you don't have it.

about your adhesions, it's very possible that all of them were cut but they adhered again. Unfortunately that's the nature of adhesions. If you have surgery to fix them, it can make them worse.

As far as the surgeon, why on earth would he say those things to you? Was it his lame attempt at humor? Only you can decide if he's a good enough surgeon to put up with his attitude. If you decide to keep him, maybe come up with something to say in return, like how you don't get to look at his records to see if he's crazy.

My first surgeon was not a very nice person, rude, full of himself, but I was told he was the best and my sugery went smoothly as did my recovery. My last surgeon was pretty full of himself, but not really rude, but I will never go back to him because I wasn't happy with the way my surgery/recovery (and his attitude about it) went. So choose your surgeon based on skill, forget the personality, you'll be out most of the time anyway, lol.

wow, lots of wonderful responses; that is why I love this place!
I know nothing about prophyria, and reading on line hasn't helped at all, so if it ends up that I have it, I will certainly be asking lots of questions, sarita! my doc actually wanted to test me a long time ago, but the test seemed like such a pain I just...didn't do it. I love having a jug of pee in the fridge, good grief what next?
I appreciate your surgeon comments. I will be very prepared and I am not gonna listen to the word crazy again this time; really, he said it probably 8 times. I don't come across as crazy, I am always so calm and intellegent with docs, I am going to see how it goes, but what a jerk. plus my GI is sure he left adhesions last time, as the pain never did go away and yes, I know with each surgery it can cause more adhesions. what a bad cycle to be in.

about these surgeons who have no bed side manner whatsoever......I think they choose surgery so they won't actually have to talk to anybody..much. If they were able to empathize and relate on a human level, they might have chosen family practice. I think these guys are brilliant , but have NO social skills as a result of years of study, or not knowing how to make friends in the first place , they buried themselves in books. They may be geniuses in the OR but extremely stunted in communication and human relation skills.
I would just be frank...and say..." I respect that you are the best in your field , but I don't deserve to be spoken to in this way. I may not be a surgeon but I am a person with an education who is deserving of the same respect I give you. "

Yoga, definatly speak up. The doc may think he is being funny. I've had a lot of docs joke w/ me; some were funny, some weren't. After tons of bad headachees from a ski injury (sans helmet) I finally had a cat scan done. The doctor looked at the screen and said "yup, there IS a brain in there." I laughed so hard I almost fell off the table. Another time I was in the hospital for a day and desperatly needed fluids. I didn't know I had crohns at the time. He pretended to "forget" if the blue thermometer was the oral or the rectal one or if it was the red. At that point, I didn't want to laugh, I could care less, and just opened my mouth. Then he kept joking with my boyfriend that he would make sure I wasn't pregnant first and foremost. Neither of us were laughing. Overall though, I got good care from him, he was just a poor comic and it was hard to tell if he was joking or not.

he is a general surgeon, but his expertise is in laparoscopies...he can pretty much do brain surgery through the belly button :) he won't be cutting through the colon, just cutting adhesions (hopefully)
this has really been a help. I needed to feel a bit "pumped up" to deal with him again. now I have to decide whether to go through it all again or just pop vicadin for a while.

The remark he made to you about "being crazy" may just be his dry sense of humor, that doesn't mean he's not a great surgeon, not everyone has "the whole package", his personality may be lacking the way he comes across but he may very well be excellent at what he does.

:)

IMHO,

I'll take the arrogant surgeon that's being recommended to me by other physicians.  You don't want somebody cutting you open and then second-guessing themselves (even if they did stay at a Holiday Inn Express last night).

BTW Judy, remind me never to come over to your house for dinner and leave with leftovers.  I had to laugh b/c I've done some pretty disgusting things with food storage containers.

Poopington McToot

My last pcp (who was about my age) used to call me "sweetie" i.e. "Hi sweetie, what can I do for you today?" Or sometimes "hon" (short for honey) Ok, I know that some people do use these words to address women but it seemed very dumb to me especially someone who came of age the same time I did and should know that this is not appropriate anymore. My next pcp, a young man, addressed me as "Mrs" which was almost as bad.

Yogaprof, I was tested for porphyria once also so it is not that off the wall. It was the above pcp who is known to be very smart. He said that anyone with undiagnosed abdominal pain and neurological symptoms should be tested for that. Often vomiting goes along with it (saw that on Marcus Welby once) but he said not necessarily.

I had two laparoscopies for adhesions and would love to know what is going on inside me right now. In the first one, done by my ob-gyn who had an excellent reputation as a surgeon, he left all the adhesions on the left side because he felt that they had been there forever (probably right) and were not causing problems. he did remove one that was tieing my ileum to my front abdominal wall and after that lap my pain was gone for 3 months. I had another lap done by a general surgeon 6 months later and when he went in, planning to leave the adhesions on the left side alone again, he found that the adhesion on the right had not reformed, yet I still had the same pain. So he started on the left side, releasing my colon. I'm fairly sure my sigmoid colon (which was stuck to my right pelvic wall) is still in the correct place (left side) because I could feel the miralax for my last colonoscopy chugging across the top of my abdomen and down the left side and then across to my middle. I had no bowel function abnormalities at the time of the laparoscopies despite these massive adhesions.

I wonder if a nerve could be trapped?

In my case, I don't think my pain was caused by my adhesions. I believe the left sided adhesions had been present since the early 1970's when I had a work up for infertility. The xrays, even though they can't show adhesions, suggested them- they could tell that there was a mat of "something" on that side. I was scheduled for surgery by my ob-gyn but apparently the dye flushed my tubes and I became pregnant first, the surgery was cancelled and I never did find out what was going on. Then in 1986 I had a hysterectomy and my ob-gyn said there was signs of "old endometriosis" He didn't say anything about my left side being such a mess. So, these left sided adhesions might have been present just from 1986, as a result of the hysterectomy. All during these many years I had no unusual abdominal pain. This is why I don't think my left sided adhesions were responsible for my pain. This doesn't mean that your pain isn't related to your adhesions though. And again in my case, I had the pain return 3 months after the first lap, never had any more laps done, take pentasa and the pain is gone. (I also got relief from various meds like tricyclic antidepressants and also flexeril. Both of these drugs also work on pain transmission besides their other mechanism of action)

The ob-gyn who did the first lap never did believe I had a gyn problem. He told me right away that he thought it was probably crohn's but after 9 months agreed to do a lap and then when he saw the right sided adhesion tieing my intestine like a sausage he though well, maybe, worked on that one but left the others alone. He was present at the second lap, said he wanted to see for himself what had happened in the meantime. Not long after that he died.

In your case, I still can't understand why all your tests showed crohn's the first time if it isn't crohn's. I know how frustrating this must be for you.