Might I have a case?

[Sabbykins]

First off, I'm from Knoxville, TN.

Since this is a little long, I'll summarize it first, and if it sounds interesting, you can read the long version below...

My doctor failed to diagnose obvious neurological degeneration or hospitalize me despite my request, visited him at least six times in two months, each time getting worse and worse and complaining of neurological symptoms that worsened at each visit. Neuropathy could have been prevented or lessened with proper diagnosis and care. When I went to my surgeon, who is an absolutely wornderful practitioner, he immediately recognized the problem and hospitalized me promptly. I had been to my regular physician only days before that.

I guess that's the short version...If you want to read the long version, here it is:

This is the first time I've ever had to seek legal counsel, but I believe my doctor was VERY negligent in diagnosing a condition that has left me with permanent physical impairment. My story is a little long, but I appreciate any information I can gather, as I'm not entirely sure how to "shop" for lawyers...

In May of 2004, I had a gastric bypass operation, with no complications afterwards. In August, I started to develop post-op aneorexia, and could not keep any food down. This went on for two months, with NO food and only small ammounts of water. I told my PCP, Dr. Simm of Dr's Care West, that I was having trouble keeping food down. He put me on anti nausea medication, which did not work. I started going to the emergency room, and went there at least five times in the two months this problem was going on, as I kept becomming dehydrated from being unable to drink much and vommiting what little DID hit my stomach. I started falling at the end of September, my vision began to blurr as my eyes couldn't focus on anything. My balance began to disappear, and I fell several times. At the emergency room, they gave me IV potassium and sent me home. My physician did similar. I went to my PCP several times, who said it's "just your potassium from vomiting so often" (I was throwing up spit at least ten times a day at that point...) He gave me a prescription for potassium, which I took, but still was having neurological symptoms that were obviously worsening. At first I complained of the numbness in my feet, then began complaining of numbness in my hands as the neuropathy worsened (he never diagnosed it, and did not hospitalize me despite my requesting it and complaining of obvious neurological problems.) Finally I went to the surgeon who did my gastric bypass, and he immediately admitted me to the hospital. By that point, however, the damage was already done. My surgeon believes that it was a thiamine deficiency, which is known to occur after a gastric bypass. My primary physician failed to hospitalize me despite several visits that showed an obviously degenerating neurological state. At my last visit to my PCP before hospitalization, I had to use a wheelchair as I could not walk on my own anymore.

The official diagnosis is a bi-lateral peripheral neuropathy. My feet and legs were completely numb, and devoid of any sensation at all. I could not walk or stand on my own, though now I can walk SHORT distances with a cane, and that is after 5 months of therepy. My toes are almost completely paralyzed and do not bend down at all. Neuropathies are considered permanent, and tend to progressivly degenerate. I am on daily doses of morphine, neurontin, and cymbalta to combat the agony of the neuropathy. (Dr. Simm also did not give pain medication when I could not stand a feather-touch on my feet, which caused me to almost overdose on OTC pain medication. Later on my neurologist tried Hydrocodone, of which I took 60 in a one-week period to combat the pain, until they tried me on Avinza extended release Morphine.) I am expected to be on medications the rest of my life for this disease that would not have happened if I had been properly diagnosed in the first place.

I feel that this disease and it's permanent side effects could have been avoided if I had recieved proper medical care. When a patient comes into an office unable to walk, unable to focus their eyes, and obviously following a pattern of neurological debilitation as documented by said Dr's visits, a physician should NOT send them home, but to a hospital pending a full and complete diagnosis. I am 21 years old, and will spend the rest of my life with physical problems caused by Dr. Simm's negligence. I want to know if I qualify for any compensation for a condition that could have been lessened, or even prevented, if I had been properly diagnosed and treated in the first place.

 

[rmet4nzkx]

You are very young for GBS which is a serious surgery with complicaitons, including, death. One of those complications is neuropathy which can be caused by nerve damage during surgery or malabsorption following surgery, so more than likely it is not a matter of misdiagnosis but a diagnosis of elimination following surgery. If your medical condition is the result of thiamine deficiency, you could have had a lab test, that does not require hospitalization. I suspect you are either not telling us the whole story or you don't understand what has happened. Before you had GBS the surgeon should have given you informed consent, did you read and sign such a document? How heavy were you before the surgery? How much weight have you lost? What vitamines and supplements are you taking? As long as your post is it repeats a lot of unnecessary information and lacks much infromation. What other health conditions, diabetes?

At this point, no one can determine if this was the consequence of the surgery or neglience by a health care provider, not necessarly the one you think it is. If it is Thiamine deficiency, was that the result of the vomiting, malabsorptive symptoms which may be more serious with an increased risk of anemia and loss of fat-soluble vitamins (vitamins A, D, E, and K). Adequate amounts of iron, calcium, and vitamin B12 may not be absorbed. This can cause metabolic bone disease and osteoporosis.

Stomal stenosis occurs when there is a stricture (tightening) of the opening between the stomach and intestine. When this occurs, vomiting after eating and sometimes after drinking may occur. Stomal stenosis can be treated easily but should be treated immediately, was this one of the things they were treating and not misdiagnosis? Here are some of the risks of the surgery

As with any major abdominal surgery, there are risks directly associated with gastric bypass. Although measures are taken to reduce the risks of these complications, they are sometimes unavoidable. This chart lists some complications for open gastric bypass,
Major wound infection 2%
Incisional Hernia (rate for open gastric bypass) 20%
Stomal Stenosis (causes temporary vomiting after surgery) 12%
Ulcer 9%
Gallstones (with anti-gallstone medication) 2%
Blood clots in the lungs 0.5%
Leak from the hook-up/peritonitis 1.5%
Death 1%
Here is an article from the Mayo clinic on your condition.
Mayo Clinic in Rochester

Thursday, October 14, 2004
Gastric Bypass and Stomach-Stapling Patients Should Recognize Risk of Nerve Injury Post-Surgery

Following Nutritional Guidelines and Not Losing Weight Too Fast Key to Prevention

ROCHESTER, Minn. -- Mayo Clinic researchers have found a significant number of patients who undergo “stomach stapling” or gastric bypass surgery for weight reduction develop peripheral neuropathy, damage to any of the body’s nerves outside of the brain and spinal cord. The development of nerve damage is associated with malnutrition, and so the researchers contend may be largely preventable with proper nutritional care.

“Surgeons who do weight-reduction surgery and the general public and should be aware that nerve damage is a frequent consequence of the surgery,” says P. James (Jim) Dyck, M.D., Mayo Clinic neurologist and lead investigator in this study, which will be presented at the American Medical Association Science Reporters Conference on Oct. 14 and published in the Oct. 26 issue of the journal Neurology. “I’m not saying that people shouldn’t have this surgery, but I am saying that there are real potential complications and that good follow-up care is necessary.”

The Mayo Clinic investigators found that 16 percent of weight-reduction surgery patients they studied developed a peripheral neuropathy: nerve problems ranging from minor tingling or numbness in the feet to severe pain and weakness confining patients to wheelchairs.

“It’s surprising how many of these patients developed peripheral neuropathy,” says Dr. Dyck. “Sixteen percent is a large number. But patients who were part of nutritional programs before and after their weight loss surgery generally didn’t develop these neuropathies, so we believe the nerve damage is largely preventable.”

Dr. Dyck and colleagues identified risk factors in weight-reduction surgery patients who later developed nerve problems: 1) they lost weight at a much faster pace, 2) they received less nutritional supplementation, 3) they experienced prolonged nausea and vomiting, and 4) they failed to attend nutritional clinics.

“The evidence is very strong that nerve complications are associated with malnutrition,” says Dr. Dyck.

Some forms of malnutrition are well recognized to cause peripheral neuropathy, such as thiamine deficiency in the disease beriberi. Rather than the surgery being a direct cause of neuropathy, the associated rapid weight loss and prolonged nausea and vomiting can lead to malnutrition and neuropathy.

An important key to preventing peripheral neuropathy is to seek a robust program with presurgical and postsurgical care by a multidisciplinary team of specialists who can oversee the patient’s nutritional status. “Don’t just choose a surgeon, choose a program,” says Dr. Dyck. “Patients in our study who were not part of programs were more likely to end up with nerve problems. This is a life-changing operation. It’s like having transplant surgery -- you need long-term follow-up.”

Michael Sarr, M.D., a Mayo Clinic weight-reduction surgeon who participated in this study, adds, “It’s a risky operation, but it’s a calculated risk in that morbid obesity is life threatening. Obesity can cause sleep apnea, diabetes untreatable by insulin, excess fatty substances in the blood, and coronary artery disease. Weight-reduction surgery shouldn’t be taken lightly, but it has tremendous benefit to select patients.”

Dr. Dyck and colleagues embarked on this study due to a pattern they observed in the peripheral neuropathy clinic. “We’d seen patients with nerve problems in our clinic who’d had weight-reduction surgery,” he says. “We saw the association, and we wanted to test it in a scientific way.”

The investigators searched the charts of 435 patients who had undergone either Roux-en-Y gastric bypass or vertical banded gastroplasty, also known as “stomach stapling,” at Mayo Clinic or other medical institutions to determine who later developed peripheral neuropathy. Three nerve disorders were identified in the study patients: 1) sensory predominant neuropathy, marked by pain and/or sensory loss, usually in the feet, 2) mononeuropathy, involving individual nerves, as in carpal tunnel syndrome, and 3) radiculoplexus neuropathy, marked by weakness, sensory loss and/or pain in a patchy, multifocal way. Radiculoplexus neuropathy can have the most serious consequences of the three, including confining a patient to a wheelchair.

To ensure that peripheral neuropathy was not linked to just any abdominal operation, the team also identified a control group of 123 obese patients who had undergone open gallbladder removal, another abdominal surgery. Only 3 percent of the control group developed a peripheral neuropathy.

“This is highly statistically significant,” says Dr. Dyck. “We believe that the peripheral neuropathy relates specifically to the weight-reduction surgery and not just any type of abdominal surgery.”

Dr. Dyck and colleagues have not yet studied whether these nerve problems are reversible. “We don’t know what the long-term outcomes will be for these patients,” he says. “Nerves can regrow, and there are people who have improved.”

According to Dr. Dyck, this is the largest and most systematic identifying patterns of neuropathy in weight-reduction surgery patients. It also is the first to use a control group to look for an association between weight-loss surgery and nerve problems, and the first to identify risk factors for developing peripheral neuropathy.

 

[Sabbykins]

Thanks for your response! I will try to be a little more clear.

At the time of the operation, I weighed 315 lbs. I had been over 300 lbs since age 10. I was aware of the risks and complications that could arise. When I began having the eating problem, stricture was the very first thing my surgeon looked for, but endoscopy showed that I had a normal, functioning stoma. Also, the bypass portion was proximal, since I only needed to lose 160 lbs. or so. I can ask my surgeon for the exact ammount bypassed, if that information will be useful.

When I began showing neurological signs, I recognized them and pointed them out to my PCP, and asked for a thiamine test (as I had a sneaking suspicion that bera bera was at play). Dr. Sim said that I had not been post-op long enough to develop a thiamine deficiency, and did NOT run the blood test for it. (the test was never ran until my surgeon hospitalized me - I had two thiamine tests in the same day, results took four days to recieve back, but the initial test showed sub-normal thiamine levels, while the second test taken showed my thiamine on the low end of normal, taken after IV thiamine was administered.)

If not for my surgeon, I very well may have died, as the neuropathy worsened in a rapid manner. That's why I kept going back to my PCP begging for something to be done. IF my thiamine had been checked as suggested, then the neuropathy could have been halted or lessened. My basis for that is that after I was hospitalized for a week, I began to improve slightly (I could stand for a few seconds without collapsing, and take a few steps, although that caused a fall and a sprained ankle in the hospital. I'm not concerned about that, as it was my own fault for trying to do too much at once.) After hospitalization and the thiamine IV, I showed progressive improvement, although now it has stopped and I am at a plateau in recovery from it. My neurologist believes that I will probably never gain full function of my feet again.

In the weeks leading up to my hostpitalization, I went to my Doctor several times. I was getting worse, obviously, and showing ALL of the symptoms of a thiamine deficiency, and obvious symptoms of neurologic distress that were progressively worsening, and yet my doctor insisted it was a potassium deficiency and refused to test for anything else (I lacked any cardiac symptoms which are usually associated with a true potassium deficiency as well). Luckily, I have extensive medical records from the doctor, the emergency rooms, my surgeon, and now a neurologist after the fact. I was desperately seeking an answer, and when the potassium suppliments did not even begin to alleviate my symptoms, the doctor should have examined other causes while still treating the potassium deficiency.

Again, he never diagosed even the possibility of a neuropathy or neurological damage, despite obvious progressive degeneration that is documented by emergency rooms and his own office.

If a patient goes from walking to being in a wheelchair in the period of a month, combined with other neurological symptoms and complaints, I think the doctor SHOULD have hospitalized me, or at the very least referred me to a qualified neurologist at the obvious onset of those neurological symptoms. He failed to do either.

Post operatively, I was taking a multivitamin as well as supplimental thiamine, calcium, iron, and other vitamins. When I became sick and began throwing up, I could not hold them down. I still took them daily, but could not keep them in my stomach.

Both my surgeon and my neurologist agree that the neuropathy is NOT related to the surgery, but to a nutritional deficit caused by not eating for a prolonged period, and not being treated properly at the onset of the symptoms.

If you need any more information, I am more than happy to provide it. Sorry if my posts get confusing, I'm trying to be thorough but at the same time I forgot to mention some of the more fine details.

 

[Sabbykins]

Also, to answer the other questions that I forgot in my previous post - I had no comorbidities, was very healthy except for the obesity. The surgery was preventive, as it is better to avoid having problems that would almost definately arise later in life due to the prolonged obesity. I was never able to lose weight, in fact the only time I ever lost weight on my own was during my pregnancy in 2003, I went from 335 to 320 at delivery in Ovtober, 2003, and down to 299 within the two months after the delivery. I had gained back to 315 by May 2004.

I now weigh 175, and am 25 lbs. from my goal weight of 150. I no longer try to diet, as I believe trying to diet was what triggered the eating disorder. To me, making sure that the incident does not repeat itself is priority, as I am no longer considered obese (5'8, 175. Still overweight by medical standards, but not obese and only one BMI point overweight.)

Hope this helps!

 

[rmet4nzkx]

As you'll notice in the Mayo article, nutritional support both prior to and following is key and most of the malabsorption complications occur in those without good control. This is the most common complication, so if your cause of action is based on misdiagnosis, you are going to have a hard time proving it because your PCP is not the only person responsible and it is a known risk of the procedure.

Were labs done prior to surgery to get a baseline? Why didn't your surgeon order labs before and after surgery? Why didn't the ER refer you to a neurologist? Why didn't they do a test? Did you try going to UT or Vanderbuilt for a second opinion? Were you on a program to boost your nutritional levels prior to surgery? Your PCP is correct, if all this occured within 1 month, that is not long enough for the post surgery malabsorbtion to be the cause and if that is the case your levels may have been low to begin with greating increasing your risk. BTW you can have a potassium deficiency without cardiac symptoms.

If you have been morbidly obease since age 10, you more than likely have a lot of relearning insofar as diet. Are you working with a dietician?

As the MAYO article said there can be recovery from the neuropathy, and believe it or not, you may be able to walk even without total recovery of feeling.

Are you allergic to any medications or had any adverse drug reactions, if so what?

 

[Sabbykins]

My surgeon has a wonderful aftercare program, including a dietician and fitness counselor. That was the main selling point of using Dr. B as a surgeon, in fact I even moved to be near him for the first year post-op. My surgeon has regular aftercare appointments at 2 weeks, 4 weeks, 3 months, 6 months, one year and I think every year thereafter. This problem occured between months 3-5 post operatively, not one month, and I appologize if I gave that impression. I had a full work up of all of my levels pre-op, and was scheduled for another at 6 months post op through my surgeon.

I also failed to mention, I visited two emergency rooms through this ordeal. Both referred me back to my PCP to fix the problem. On the first day I began noticing balance problems and vision problems, I went to the emergency room, and fell while trying to walk back to the ER holding rooms (at that point I was "locking" my knees and widening my gait for balance. If I bended my knees while walking, I would collapse as happened earlier in the day). I could not stand up on my own despite trying, and had to be picked up and placed in a wheelchair. I didn't know until recently that the hospitals could also be at fault, as each time I went to the emergency room they called my PCP who said (and this is of course not verbatum, as I did not hear the conversation but was told by the ER doctor at release,) "Don't admit her, send her to my office tomorrow." If they do have some fault in it I would like to know, as I am uncertain about the practices of emergency rooms and asasumed they were simply acting on the advice of my PCP.

Also of mention is due to my insurance, the only way to get a second opinion was through emergency rooms. At that point I didn't know my PCP was being negligent, and believed what he said, so I did not want to change providers, wait a month for an initial visit, then change back to the walk-in clinic that I used.

My potassium levels were low at both ER's and my PCP's office, but always between 3.2, 3.4, and 3.6, which is low, but not extremely so (I believe the normal levels are 3.5-5.0, correct?) You're correct about a potassium deficiency not always presenting cardiac symptoms, but from what I've read they frequently do, which is why I thought it deemed mention.

I guess I should have mentioned in the first place what triggered the eating disorder.

I have bipolar disorder, mixed, and have been under counseling and on medication for the past two years (even though it first developed as a juvenile at age 12, and was misdiagnosed as borderline personality disorder, sociopathic tendancies, phase of life problems, oppositional defiance disorder, and about three more axis 2 disorders that I cannot recall at the moment. Turns out, as an adult when I got a second opinion, I was bipolar, and have had three psychologists and two psychiatrists agree on that diagnosis, plus showing very few cycles after being medicated as such.) I guess what I am going for with that, is I am disabled and on SSI, that being the sole income for my husband, son and I, other than food assistance from the government...(when I think of the term "food stamps" I always think of those people in the poor rural community where I grew up, who lived in filth and wanted no change in that. I've always believed myself better than that, as I have aspirations for a better life, at least. But that is neither here nor there, just a sideways glance into my psyche...) But anyway, back to the story...

In late august, we had NO money, and little food and no way to change that situation for a week. Given that I did not feel hunger at that point, I decided to use what little food I had to feed my son and husband. After that week, I could not hold any food down despite trying, and would vomit everything up. At that point I began going to the doctor for it, as I knew immediately that was NOT a good thing.

I went either to the doctor or an emergency room at LEAST once a week from that point onwards, trying to figure out what in the name of Daisies was causing me to throw up. That is still open to speculation, as no reason was ever found, and I assume given my disorder that it was my fault and mental.

I suppose the point I am arguing for, is that I told my doctor these facts. I begged for treatment. How long should a patient go without eating anything (I think I had a single bite of a waffle in September, but I threw that up as well) and telling their physician this, as well as having an obvious degenerating state, before the doctor takes notice and hospitalizes the patient? If I were being secretive about not eating anything, it would be another story entirely...But the fact is, I realized I had a problem and sought treatment.

The number one argument I have, really, is the almost immediate improvement after thiamine was delivered. I could stand on my own for short periods within a few days. I requested that my thiamine be checked at my physicians office on at least two different occassions, both times the test was refused to me.

I do hope that I will be able to walk again. I would rather have use of my legs than all of the money in the world...I had the surgery to become more healthy, and now, what is the physical size ability to walk and excersize, when you don't have the use of your legs? While I know that is a risk of the surgery, it was not caused directly by the surgery, as it was not caused by the malabsorbtion, but by an eating disorder that caused me to eat NO food in a two month period.

Also, I have no drug allergies, and have never had a reaction to any sort of medication...The only allergy I have that I am aware of is of bee stings, but I've not had one of those since I was about seven.