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Hi All,

For the second time since my jpouch surgeries in 1999, I need a revision because the pouch has grown up into my abdomen. The first time was in 2010 or 11, and the doctor just cut the overgrown top off and  attached it to the small intestine - no ileostomy needed. My surgeon here just disappeared last week and there is no one else in the state who has any experience with this. I was told I should go to Cleveland Clinic or Mayo, but given no suggestion of who to see. So I need to tell them who to send the referral to. Anyone know of who the expert on this type of thing is at either CC or Mayo? If you had a bad experience, please let me know about that too, so I can avoid that doctor. I absolutely cannot have an ileostomy again because I am highly allergic to the adhesives on the appliances. In my two-step original surgery I spent most of the time in the shower with the stoma doing it's thing, because my skin was destroyed ,bloody and ulcerated.

The issue, I was told by another doctor in the practice who took over for the surgeon who left, is that my blood supply might be a problem and I have about a 50% chance of having an ileostomy - temp or permanent - when I wake up from surgery. The hope is that the specialists who deal with this at CC or Mayo have some tricks up their sleeves for blood supply issue. Any help would be appreciated since I've been waiting a while for this surgery and was scheduled for July 22. And now have to start all over, which can't start till I have someone for the doctor's office to send the referral to. Thank you!



The attached images are - Xray - see the big air filled thing that grew up the side and goes across under the ribs? The Contrast Dye image is reversed but it's the same thing. It just looks different on different days because it moves, and that's how I get partial Image is reversedXray.

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  • Image is reversed
  • Xray
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Dr Remzi is the best!  But he is no longer at Cleveland Clinic.  He is at NYU Langone in New York City.  He is hands down the best surgeon for what you need.  My son was also an extremely difficult case, with Dr. Remzi redoing the original pouch.  In addition to doing several huge surgery’s.  Just tell him Jeffrey sent you!  He is worth the trip to NY.  

Thanks everyone. So I looked at his website. And he doesn’t take my insurance, which is Blue Cross Blue Shield, which I thought was widely accepted. Anyway, anyone with experience on this type of issue? I lost my job last month, have limited funds, and have a pretty good ACA plan, but it does no good if the doctor doesn’t take it. Have y’all heard of him working something out with people with difficult finances?

@tulsamom posted:

Thanks everyone. So I looked at his website. And he doesn’t take my insurance, which is Blue Cross Blue Shield, which I thought was widely accepted. Anyway, anyone with experience on this type of issue? I lost my job last month, have limited funds, and have a pretty good ACA plan, but it does no good if the doctor doesn’t take it. Have y’all heard of him working something out with people with difficult finances?

Damn! I never heard of Blue Cross BlueSHield not being accepted, that is widely accepted. I would call the office and ask them, maybe their website is limited in info. Definitely call them and let us know what happens

I did just call and they say they do take it. I have a virtual appt. with Dr Remzi in September. Going to get my local doctor to send the referral and medical info to them tomorrow. I never thought I’d get to meet the famous Dr Remzi I’ve been reading about here, all these years. I’m sure he’s dealt with my issues before. Thanks to everyone!

@tulsamom posted:

I did just call and they say they do take it. I have a virtual appt. with Dr Remzi in September. Going to get my local doctor to send the referral and medical info to them tomorrow. I never thought I’d get to meet the famous Dr Remzi I’ve been reading about here, all these years. I’m sure he’s dealt with my issues before. Thanks to everyone!

So happy you called!!!! Bluecross BlueShield is so popular

Hey,

That part at the top under my ribs, I always thought was the top of the overgrown jpouch where it attaches to the small intestine. But looking at it, it looks like the actual original j pouch structure. If that’s true, then what the heck is the big arm sized pouchy part that comes up from the pelvis? Any ideas? I suddenly am very confused. What does it like like to you all?

@tulsamom posted:

Hey,

That part at the top under my ribs, I always thought was the top of the overgrown jpouch where it attaches to the small intestine. But looking at it, it looks like the actual original j pouch structure. If that’s true, then what the heck is the big arm sized pouchy part that comes up from the pelvis? Any ideas? I suddenly am very confused. What does it like like to you all?

I would love to know that too! I tend to get confused when looking at x-rays of our pouch

@tulsamom, I see you have an appointment with Dr Remzi booked in, but I also wanted to suggest Dr Holubar.

https://my.clevelandclinic.org...22497-stefan-holubar

(Sadly I haven’t seen him myself, because I live in Australia, but I have heard good things about him and he has published some good research.)

My j-pouch has also done weird things. Mine just became enormous all over, which is called megapouch.

I am not sure whether your complication would be considered to be under that banner, but if you search the forum I made a post with links to papers on the topic that might be of use.

I too am trying to avoid a perm ileo. I developed my problems with adhesives recently though, and nobody will believe me. Adhesives can cause awful damage, but I even had a nurse at a hospital say to my face “We only want to hear about real allergies” when I tried to mention it. (Luckily I wasn’t admitted to that hospital!)

@Kushami posted:

@tulsamom, I see you have an appointment with Dr Remzi booked in, but I also wanted to suggest Dr Holubar.

https://my.clevelandclinic.org...22497-stefan-holubar

(Sadly I haven’t seen him myself, because I live in Australia, but I have heard good things about him and he has published some good research.)

My j-pouch has also done weird things. Mine just became enormous all over, which is called megapouch.

I am not sure whether your complication would be considered to be under that banner, but if you search the forum I made a post with links to papers on the topic that might be of use.

I too am trying to avoid a perm ileo. I developed my problems with adhesives recently though, and nobody will believe me. Adhesives can cause awful damage, but I even had a nurse at a hospital say to my face “We only want to hear about real allergies” when I tried to mention it. (Luckily I wasn’t admitted to that hospital!)

That is insane that you got treated that way!!! WTF is wrong with those people! Whatever happen to empathy and compassion???

I never heard of Mega pouch, but I believe it!

What is your plan going forward???

@Kushami Thank you for that. I will go right now and read about it. The radiology report referred to it as:  large patulous relatively adynamic j-pouch extending from the pelvis into the right upper abdomen and crossing midline to the mid abdomen. But megapouch may just be it because I read that it doesn't usually happen till 10 years after pouch creation and the first time this happened to me was 10 years in and now it's 13 years post that revision.

And, the fact that you have the rare adhesive allergy as well, makes me think they are related. Both rare conditions. We are rare jewels! I am curious how it all turned out for you. What was the process etc? You can DM me if you don't feel like discussing it here. Thanks so much for coming forward!

Hi,  wishing you the very best of luck!
You are doing the best thing ever going to get Dr Remzi’s opinion, h’s the best there is.
I have followed him from Cleveland to NY for the last 2 of my numerous surgeries. He certainly has the greatest amount of experience in difficult pouch situations!

Also is a very kind and caring physician.
I would be glad to speak to you about my experiences.
It always worth a journey to get the best. I do get most of my care, btw,  at the Cleveland Clinic, so I am very grateful for their care for many many years!!

Again,hang in there, we are all praying for you and sending the best thoughts !

Janice

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