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

[L Marcelle]

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

 

[SAM55]

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?

 

[L Marcelle]

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?

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.

 

[TiaLi]

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.

 

[L Marcelle]

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.

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.

 

[TiaLi]

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.

 

[L Marcelle]

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?

 

[TiaLi]

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).

 

[L Marcelle]

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).

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.

 

[TiaLi]

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!

 

[L Marcelle]

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!

I will do. Thank you

 

[L Marcelle]

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!

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?

 

[TiaLi]

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.

 

[L Marcelle]

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.

Ok. Thanks. What usually happens in this appointment?

 

[TiaLi]

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.

 

[TiaLi]

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.

 

[L Marcelle]

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.

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 ☺

 

[TiaLi]

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.

 

[Maria61]

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 ☺

Good luck to you x

 

[L Marcelle]

Good luck to you x

Thank you