What kind of Dr. put in your PEG?

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halfin

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Joined
Jun 29, 2009
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540
Reason
PALS
Diagnosis
08/2009
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US
State
CA
City
Santa Barbara
I have a choice between two different specialists to put in my G-tube. At the ALS clinic down at UCLA, it is done by Interventional Radiology. Here locally we would have a gastroenterologist (stomach doctor). The radiologist would use X-rays to guide the placement. The stomach guy uses a scope down your throat to see what's going on.

The advantage of radiology is that UCLA does a lot of these and would see more PALS. But the local stomach doctor assures us that these are very routine and he has plenty of experience. Follow up would be much easier locally vs UCLA which is two hours away.

PEG insertion stories seem to have wildly different outcomes here, from problem free outpatient procedures to terrible difficulties and complications. I wonder if it has anything to do with the kind of specialist who does the procedure?

I'd be interested in hearing from people with PEGs about how it was done - thanks!
 
I think the bad experiences we have read about is because the doctor was the wrong kind and has not done many of them. I had a gastrologist do mine and it was quick and easy with no pain or problems of any kind. I know a few PALS that used the same doctor and the same experience as me.
 
Have no personal experience, Hal, but my first questions would be: how many times have you done this procedure? how many times have you done this procedure on PALS?
(and seems like you have covered these) how many patients experienced complications? ( the records may be "sketchy' here! :shock:)

I can tell you my BIL had a PEG placed in May (neck & throat cancer; impending radiation & chemo) by a G-I guy at large university hospital. (not sure of his experience with PALS, but in full disclosure, this is the same hospital that is connected to our ALS clinic.)
He had no complications from the procedure or the tube. Tube is working fine. Best of luck!
 
Hal, our gastroenterologist has done well over 3,000 of these. There were no problems with the actual procedure, the problems we had were in the follow up. Be sure that you will receive instructions on how to care for the PEG. Know and understand any and all complications. There is no question that the most qualified person performed the procedure, he just didn't have personnel that understood the importance of follow up.
 
Mom had her surgery scheduled through Gastroenterology, but as they were scoping her, they became hesitant of going any further. They found that she had an open space between her stomach and abdominal walls and feared that something could be floating around in there, and they didn't want to take the chance of hitting anything as they made the incision. We were fortunate that Interventional Radiology was available and was able to still do the surgery the same day in the same facility. She had no complications from the procedure...and didn't take the first bit of pain medication in the following couple of days...only an ice pack on the site.
 
Mr Hal, we had the GI surgeon here at Vanderbilt that was working closely with the ALS specialist perform my husbands procedure this past Thurs. He did a great job, only took abour 15 min to actually put it in and due to it being done at same facility and he, the neuro, and anesthesia all worked together and decided what was best as far as being put to sleep to ensure the best outcome possible. All is well, feedings are going fine, just sore.

Amber
 
Ours was done by a gastro. "Such a simple procedure"was how they described it, and it was, however they gave no info as what to do after. If you have a choice as to do it outpatient vs inpatient, go for the inpatient. I feel it is criminal that all PALS are not kept overnite just in case. Also, go very easy on eating food by mouth for the first 48 hours. My PALS was starving, and we were told he could resume his normal diet within 4 hours of the procedure, and he ate a big meal, and the pain was intense.
 
Hal, Mine is going to be done by IR. I have a lap band on my stomach and I want them to be able to see where they are placing the PEG. It will be done under general anesthesia on an outpatient basis, done at the hospiatl.

Best of luck with yours. You will do fine.
 
Hi Hal,
How soon is the follow up after the surgery?My ALS Clinic is four hours away.
 
Thanks for the good advice. I had the PEG put in Tuesday by our gastro doctor, and stayed overnight at the hospital for observation. Everything went well but I'm glad I stayed. I had a couple of episodes where I felt faint and sick for about five minutes and Fran got scared. It was good to have the nurses there. The doctor thought the air in my stomach was pressing against my vagus nerve, which can cause that. I was also dehydrated because drinking even water after my surgery caused painful stomach cramps. They put me on an IV drip and soon I was peeing every two hours.

Also we got fantastic instruction by the nurses. They put water in the tube the next morning, waited an hour, and gave me a can of formula. They talked Fran through the dressing change too, and sent us home with a bunch of supplies. Our first case of food came that night (last night) and a home nurse came by today to help Fran with the dressing change and a feeding. The dietician at the hospital sent us home with a feeding schedule as I transition to more calories from the tube.

The main problem was I slept very poorly - hardly at all actually. I wanted to try a different bipap mask because I haven't been happy with mine, but theirs was terrible and kept me awake with leaks. Also I like to sleep on my side but I couldn't get into that position in the hospital bed. Plus I kept waking needing to use the urinal due to the IV. Normally I can go 7-8 hours at night.

Still it was worthwhile, the soreness is halfway gone and it's nice to eat without choking.
 
Now this is the way it is supposed to be done! A poor nites sleep in the hospital was a small price to pay for the excellent care you received. Our's was done through Medicare and they do not approve overnite stays. So glad it went so well!
 
Ditto what Lori said! So glad things went so well; you & Fran will be pros at the feedings in no time!
Sweet dreams & sleep tight in your own bed!
 
I'm so glad you got the care and attention that you needed. We have still never received any training on the PEG. My husband got it in July. We haven't needed it yet, but I would still like SOME training! Glad it all went well!
 
Hal- Glad things went fairly well for you. Its nice to hear when theres a good outcome without much trouble to get there.
 
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