Sleeve done elsewhere: how to move your follow-up care

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Sleeve done elsewhere: how to move your follow-up care

If your gastric sleeve was done by another surgeon, in another state, or abroad, you still need regular follow-up, vitamin and blood test monitoring, and an evaluation of any problem. Start by gathering your surgical records. Then call the Rancho Cucamonga office and ask whether Dr. David G. Davtyan, MD, FACS, FICS, FASMBS, can see you. If you are within weeks of surgery and feel unwell, do not wait for an appointment.

Why sleeve patients end up without a surgeon

The 2022 ASMBS/IFSO guidelines describe severe obesity as a chronic disease that needs long-term management after a first operation. The 2019 AACE/TOS/ASMBS clinical practice guidelines likewise list the need for lifelong lifestyle support and medical monitoring among the things to weigh with bariatric surgery. In practice, people can lose touch with the program that operated on them.

Common reasons are a move to the Inland Empire, a change of job and insurance, a surgeon who has retired or closed a practice, surgery done during a trip abroad, or simply feeling well and letting visits lapse. None of them is a reason to go without care.

What to gather before you call

Operative report. It records the date, the surgeon and hospital, how the sleeve was sized, and whether a hiatal hernia was repaired at the same time.
Discharge summary, which notes any problem during the hospital stay.
Pathology report on the removed part of the stomach, if you were given one.
Test reports from before or after surgery: endoscopy (a camera exam of the esophagus and stomach), upper GI X-ray, and the images on a disc if you have them.
Recent blood tests, especially vitamin B12, iron, vitamin D and blood count.
Your weight history: weight before surgery, lowest weight, and weight now.
A list of everything you take, including vitamins by brand and dose, acid-reducing medicine, and any GLP-1 medication.
Insurance card and photo ID.

Under the federal HIPAA privacy rule (45 CFR 164.524), a US health care provider generally has 30 days to act on a request for your records and may take one extension of up to 30 more days. You can also ask, in a signed written request that says where to send the copy, for records to go directly to another doctor. If you cannot find everything, gather what you have and mention what is missing when you call.

If your sleeve was done outside the United States

The ASMBS position statement on travel for bariatric surgery says surgical providers should make sure all medical records and documentation, including imaging, return with the patient. The CDC's medical tourism guidance tells travelers to get copies of their records before coming home and notes that records may need translating into English. If you came home with little paperwork, email the hospital or the coordinator who arranged the trip and ask for the operative report and discharge summary. Spanish is spoken at the office, so mention it if your records are in Spanish.

Always tell US clinicians where and when your surgery was done. A CDC report in Emerging Infectious Diseases (2022) described extensively drug-resistant infections in 38 US patients with confirmed or probable cases after procedures in Tijuana in 2018 and 2019, most of them sleeve patients, and said US patients and providers should be aware of this risk after medical tourism. Knowing the location helps a doctor choose the right tests if you have a wound or abdominal infection. See also gastric sleeve in Mexico versus local care.

What a new surgeon's evaluation usually covers

A first conversation with any new surgeon is usually about how you are now: what you can eat and drink, heartburn or regurgitation, vomiting, bowel habits, energy, hair and skin changes, and how your weight has moved since surgery. From there, the evaluation tends to sort into one or more of these:

Routine monitoring. Reviewing your supplements and blood tests that are overdue. See vitamins and lab tests after a gastric sleeve and the follow-up schedule.
A symptom that needs a cause. Reflux, food sticking or repeated vomiting may lead to an endoscopy or an upper GI X-ray to look at the shape of the sleeve.
Weight that has stalled or returned. This starts with eating pattern, medicines and anatomy, and may lead to a talk about nutrition support, medication, or sleeve revision.

Questions to ask when you call

Can Dr. Davtyan take over follow-up for a sleeve done elsewhere, and how soon after surgery?
Does the complimentary first consultation apply to someone who already has a sleeve?
How should I send my records, and who requests them?
Where would blood tests and any imaging be done, and can my primary care doctor order them?

Insurance when you change surgeons

A new surgeon is a new provider as far as your plan is concerned. HMO and Medi-Cal managed care plans commonly need a referral or authorization for a specialist visit, so ask your primary care doctor or the plan before you book. The practice works with PPO and HMO plans that allow care with Dr. Davtyan. For any other coverage, including Medi-Cal, IEHP, Molina, Kaiser or Medicare, ask us whether we can see patients on your plan.

When not to wait for a new-patient appointment

Go to an emergency room or call 911 if you cannot keep liquids down, vomit blood, have black stools, have severe chest or abdominal pain, or have pain or swelling in one calf. In the first weeks after surgery, a fever with a fast heart rate or shortness of breath is also an emergency. Tell the staff you have had a sleeve gastrectomy, when, and where.

Call your operating surgeon or a doctor you already see for heartburn that is getting worse, food sticking more often, ongoing nausea, unusual tiredness, or numbness and tingling in the hands or feet. Do not let these wait while you look for a new surgeon. You can also call the Rancho Cucamonga office about them, and say your sleeve was done elsewhere.

Frequently asked questions

Can a new surgeon evaluate my sleeve if I have no records at all?

Often, yes, in general terms. Your history, an exam, blood tests and, where needed, an endoscopy or X-ray can show a great deal about a sleeve. Records make a first visit more useful and may avoid a repeated test, so keep trying to get the operative report. When you call the office, say that you have no records and ask how that affects seeing Dr. Davtyan.

I had my sleeve two weeks ago in another city. Can I be seen now?

That depends on the case, so call and say exactly that, with the date of surgery. Your operating surgeon remains your first contact for early questions, so call that team too. Ask whether Dr. Davtyan can see you this early. If you have any emergency symptom, go to an emergency room and do not wait for either office.

My sleeve was years ago and I feel fine. Do I still need follow-up?

Yes. The 2019 AACE/TOS/ASMBS guidelines describe a need for lifelong medical monitoring with bariatric surgery, and ASMBS advises yearly visits with a bariatric specialist for life. Vitamin and mineral levels can fall without symptoms for a long time, which is why blood tests are part of those visits. Ask your surgeon or doctor how often to be seen in your case.

Will a new surgeon blame my first surgeon if something is wrong?

That is not the purpose of an evaluation. A new surgeon's job is to describe what your sleeve looks like now and what can be done about any problem. Late issues, such as reflux or regain, can occur even after a well-performed operation. For how a separate opinion on a recommendation works, see second opinions on sleeve surgery.

Talk with Dr. Davtyan's office in Rancho Cucamonga

Dr. Davtyan is a bariatric surgeon. To ask whether he can see you for a sleeve done elsewhere, call Davtyan Medical Weight Loss & Wellness at 909-355-2525 or 877-9-BE-SLIM (877-923-7546), or use the contact page; the office is at 8330 Red Oak Street, Suite 201, Rancho Cucamonga, CA 91730. More topics are in the Rancho Cucamonga gastric sleeve guide.

Sleeve done elsewhere: how to move your follow-up care

Sleeve done elsewhere: how to move your follow-up care

Why sleeve patients end up without a surgeon

What to gather before you call

If your sleeve was done outside the United States

What a new surgeon's evaluation usually covers

Questions to ask when you call

Insurance when you change surgeons

When not to wait for a new-patient appointment

Frequently asked questions

Can a new surgeon evaluate my sleeve if I have no records at all?

I had my sleeve two weeks ago in another city. Can I be seen now?

My sleeve was years ago and I feel fine. Do I still need follow-up?

Will a new surgeon blame my first surgeon if something is wrong?

Talk with Dr. Davtyan's office in Rancho Cucamonga

Sources

More in the Gastric Sleeve in Rancho Cucamonga guide

Understanding the sleeve

Weighing your options

Getting care in Rancho Cucamonga

Adult BMI Calculator

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Glendale

Rancho Cucamonga

South Coast Lap-Band

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