2/8/2015

Let's see, an update on me and an explanation of why I stopped updating this page.

In 11/2010 I moved to Mexicali, Mexico.  Around 10/2011 I began working for a surgeon so it was rather inappropriate to continue warning about surgeons.  I decided to leave my blog but, not update it.  Key information is there on Researching Mexican Surgeons.

I currently work for Dr. Juan Arellano.  He is the Vice President of the Mexican College of Bariatric surgeons. They tend to set the tone for bariatric surgery in the country of Mexico. I suspect he will be voted in as President next term.

He also was the starting committee member to begin board certification for Mexican bariatric surgeons.  Today surgeons doing your weight loss surgery should be board certified in General Surgery as well as Bariatrics.  If they can't pass that test, should you really be going to them?

Dr. Juan is also one of two surgeons vetted in DS and he is the only surgeon in Mexico qualified to revise from RNY to DS.

I now have several f/b pages.

One is for regain and/or revision bariatric patients.

https://www.facebook.com/groups/130465167129885/?ref=bookmarks

Another is for Failed Bands.  Usually it's not the patient that fails the band, it's the band that fails the patient.  50% of bands of any brand are removed in the first 2-6 years post op, most of these people go on to revise to a better, safer surgery type and do quite well.  So, most of the time it is not the patient, it is the band.  This page is designed to help people deal with band issues and move on with their lives.

https://www.facebook.com/groups/759720587436129/

I have a page for facts about WLS.  There are so many myths and old science being posted all over the internet regarding bariatric surgery  I decided to start a page for just the facts.

https://www.facebook.com/groups/WLSFacts/?ref=bookmarks

Then, yesterday I realized there is still a desperate need to show people how to research Mexican surgeons.  So, we are working on a page that is similar to this blog but it will be kept updated.

https://www.facebook.com/groups/792773314105638/?ref=bookmarks

Please note, the above page is under construction, we hope it will be up and running in a few days or a couple of weeks.

Many people are going to these dirt cheap surgeons in Tijuana for sleeves.  Please be aware, if you do this you are not getting an actual sleeve.  This is what they are doing:

When a surgeon does a sleeve one of the biggest costs to the surgeon is the titanium.  The staples.  It's the biggest cost for medical supplies.  It takes (usually) about 8 packs of staples to do one sleeve.

What these surgeons are doing is sleeving the bottom 25% of your stomach and that takes 2 packs of staples instead of 8.  A MASSIVE cost savings to your surgeon.  Then the plicate the upper 75% of your stomach.

Well, we know plication is temporary, it does not work long term.  So a few years down the road these people suddenly lose restriction.  They go get an upper GI (barium swallow) and the find their upper stomach is huge.  At this point they call their surgeon in Mexico to ask what the deal is and the Mexican surgeon will *always* blame the patient telling them they stretched out their stomach.  They ate too much food repeatedly.

Well, you know what?  That's what we do.  We eat too much.  We always did, that is why we needed restriction to begin with.  Surgery doesn't magically fix that so we still tend to push the limits post op. If we *can* eat we *do* eat, that is what we do. That does not mean your stomach goes back to almost normal size.  Yes!  Push the limits and you can dilate your sleeve, but not to almost its original size.

Then the patient has to go to an actual "revision" surgeon to fix what is wrong and only when the REVISION surgeon is looking at the stomach can it be determined what happened.

It's not the patient's fault.  It is the fault of the original surgeon.  When you look at the stomach there isn't a single staple in the upper 75% of the stomach. Just scarring from plication that gave away and now the stomach is huge again.  The upper portion of the fundus was never removed to begin with.  This also explains why the patient is so hungry, they are still over producing Ghrelin, the hunger causing hormone.  When you remove the fundus of the stomach properly, you remove about 80% of Ghrelin.  When you leave the fundus and just sew it up it still produces Ghrelin.

Please don't go to these cheap $3500/$5,000 sleeve surgeons.  Flat out, hands down, it is impossible to do a sleeve at those prices.  It can't be done.

Either the surgeon is doing 25% sleeve/75% plication OR... he is using black market supplies.  There are medical tourism companies based in the US that sell these cheap surgeons knowing full well they are sending patients to horrible surgeons.  Oh!  The patients LOVE the surgeons!  They are nice, kind, charismatic.  They treat the patient well.  Sadly, I'd venture a guess that most people rate the skill of their surgeon on how "nice" they are.  "Nice" does not mean skilled or ethical.  It is not until a few years down the road when you lose restriction and the massive regain starts that you will realize that your surgeon wasn't so "nice" after all.

Do your research, go to a real surgeon.

If you have any questions please email me at any time.

Bipley@gmail.com
602 539 0949

Announcements

**UPDATE**

1/21/2016

Here is an update on Dr. Joffe, previously from Canada an now back in Mexico.  Be careful in choosing your doctors, please.

http://www.cbc.ca/beta/news/canada/edmonton/weight-loss-surgeon-with-licence-revoked-in-ontario-for-sex-with-patients-recruiting-in-alberta-1.3412410

A weight-loss surgeon whose Ontario medical licence was revoked for sexually abusing four female patients has been recruiting new patients from Fort McMurray to his institute in Mexico.

An Edmonton clinical ethicist said the "egregious" behaviour of Mexican surgeon Dr. Jacobo "Jacob" Joffe while practising in Ontario highlights the potential risks of "medical tourism."

"Would I be worried as a patient? Absolutely," said Brendan Leier, an assistant clinical professor with the University of Alberta's John Dossetor Health Ethics Centre.

"Unfortunately there is no mechanism, when you travel across a border, to protect Canadian patients and it sounds like the Mexican licensing bodies see the issue differently in terms of having a second chance to treat," Leier said.

A CBC News investigation found that over the last 15 years, at least 250 doctors have been disciplined across the country for a litany of patient boundary offences. Two-thirds were allowed to continue practising, and of those who lost their licences, CBC News discovered three, including Joffe, who moved to other countries to practise medicine.

Joffe is a general surgeon who specializes in weight-loss operations like gastric sleeve and gastric bypass surgery. He practised in Scarborough until December 2008 when the Ontario College of Physicians and Surgeons revoked his medical licence for sexual abusing four female patients over a period of several years.

Joffe did not contest the findings of the college's internal investigation, but those findings only apply to that specific hearing.

The committee found: he hugged and kissed some patients on their lips and told them how sexually attractive they were; had sex with patients regularly at his office, in the hospital and at their homes; and induced one woman to obtain illicit drugs, which he then used with the patient and another female patient.

Clinical ethicist Brendan Leier says patients considering “medical tourism” should first thoroughly research their potential doctors. (ualberta.ca)

The college also found Joffe engaged in sexual threesomes with two of his female patients while using drugs.

The college said Joffe knew his behaviour was unprofessional because he actively encouraged the women to conceal their relationships.

"The (disciplinary) committee had particular regard for the poignant description of the effects experienced by patients noted in their respective victim impact statements, which included humiliation, distortion of normal social relationships, fear of hospitals and physicians, destruction of family relationships, depression, psychological problems and employment problems."

The college levied a fine of $40,000 against Joffe to be used for the women's counselling.

The hospital in Scarborough, and Joffe, later settled a $12-million lawsuit with the patients.

"Preyed" upon patients

At his public reprimand hearing in 2013, as reported by The Toronto Star, a committee member excoriated Joffe.

"Your actions were utterly self-serving," Dr. Marc Gabel said. "You preyed upon the vulnerabilities of these patients and misused the trust that they had in you."

Joffe did not respond to interview requests from CBC Edmonton but in a previous discussion with a CBC Manitoba producer he expressed no remorse for his previous behaviour. Instead, he appealed to the producer's sense of humanity while asking that he not be named in a story.

"It has taken me a long time to get over the disaster in how this played in my life, and how much damage, mentally and physically, this had to do with me and in my life," Joffe said. "It has taken me so long. I mean, it is already seven years and it is not easy, okay?"

After the Ontario college revoked his licence in 2008, Joffe moved to Mexico, where he is a citizen and had received his medical degree, and opened the Advanced Metabolic and Bariatric Institute in Guadalajara.

A spokeswoman for the Ontario college said it notified the Mexican regulatory authority of Joffe's licence revocation, including the disciplinary committee's findings.

His website references a recruitment seminar in Fort McMurray in April 2012 and the institute's Facebook site featured a photo of Joffe with more than a dozen patients from there.

The website features many "success stories" of past patients, which praise Dr. Joffe and his care. Eleven of the 22 testimonials are by patients from from Fort McMurray who paid up to $15,000 for surgery, which includes airfare and accommodation costs. There are also video testimonials from Fort McMurray patients posted on YouTube.

Patients praise surgeon

CBC Edmonton contacted seven patients from Fort McMurray; only one responded.

Kelly Eby of the College of Physicians and Surgeons of Alberta says the college has no specific rules governing patient referrals to specialists.

In an email, Ria Ryan said she was "fully aware of Dr. Joffe's situation in Ontario before I booked an appointment with him for my surgery.

"He came highly recommended from a friend," Ryan said. "I received excellent care in Mexico and I came away respecting Dr. Joffe as a surgeon and a person."

In one testimonial, a Fort McMurray man said he was referred to Joffe by his local doctor. He did not respond to interview requests.

Kelly Eby of the College of Physicians and Surgeons of Alberta said she could not comment on a specific case, but she said the college has no specific rules governing the referral of patients to specialists.

"Any time a family physician refers a patient to a specialist, we have an expectation that that family physician knows that the physician they are referring to has a good quality of practice, they will treat the patients well," she said.

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3/21/11

I realize I usually post about doctors in this section but now I have to write about Netrition.com.

I can no longer suggest your using their services. I had no idea how underhanded and lowly these people are. They own a low carb message board and don't tell you they own it, edit posts to suit their needs without telling the poster, and overall are just THE most unprofessional company I do believe I have ever purchased from. I tried calling and was hung up on. I called back to find out the name of the person that hung up on me so I could write a proper letter of complaint and was told by Frank, the office manager for customer service that I don't need that information.

Be very careful of working with such unprofessional people.

3/5/11

More updates on 1800 GET THIN & 1800 GET SLIM

www.ripoffreport.com/weightloss-programs/1800-get-thin/1800- get-thin-1-800-get-thin-8c886.htm

articles.latimes.com/2011/feb/03/business/la-fi-lap-band-201 10203

abclocal.go.com/kabc/story

latimesblogs.latimes.com/money_co/2010/12/michael-hiltzik-a- death-and-1-800-get-thin.html

2/11/11

Please be aware that Thomas Umbach, MD in Las Vegas, NV sells collagen protein tablets to prevent excess skin and cellulite. This does not work, there is no known peer reviewed journal article that supports this. Excess skin is damaged skin, it's like taking these same tablets to fix damaged hair. Once it is damaged, it is damaged. It is stretched, it has lost elasticity, and the only true fix is removing the excess skin if you really don't want it. Please don't waste your money. It is bad enough that stores sell us snake oil, it is unfortunate when a bariatric surgeon does the same thing.

Collagen is great for injecting under the skin to fill small folds, but tablet versions will not work! It will not do a thing for your thighs or stomach but it will do a great deal for his wallet.

Here is one of Dr. Umbach's patients, read carefully and do your research!

http://www.obesityhelp.com/member/adwinters12345/

6/23/10

Please note that Dr. Ariel Ortiz in Tijuana, MX is claiming to have been doing sleeves for over a year, he claims over 300 sleeves. Considering he just went to my surgeon a couple of months ago to start his training in sleeves and as of six months ago he was refusing to do sleeves saying it was nothing more than stomach mutilation, it's highly unlikely he was 'mutilating' stomachs a year ago. I'd venture a guess he has less than 10 sleeves. Be careful, use common sense, find those 300 sleeve patients, heck... find 20! If he's doing almost one a day they should be posting like crazy on the boards. Do you know any? I don't. Doctors will claim any stats because if they tell you the truth that they have zippo sleeve/staple line experience, would YOU go to them? They know this so many doctors inflate their stats. RESEARCH! It's critical to your health.

If you call his office his staff will tell you I am dishonest, a troll, and use multiple IDs. Read my posts for yourself, I am not a troll. I have changed my ID from MidwesternGirl on OH to my usual, WASaBubbleButt. It's right in my sig on every single post I write, "Previously MidwesternGirl." How is that trolling? They also claim I work for my doctor, that is a flat out lie. It's just a con job, they try to discredit me instead of being honest about his stats. They are trying to sell you surgery, I sell nothing. Look for yourself, am I selling anything on this blog? In my posts? No, I am not. What do I have to gain by your believing me over someone trying to sell you a very expensive surgery type?

Just do your research.


6/13/10

1 800 GET THIN and 1 800 GET SLIM - WARNING:

From the news article:

Brooks had surgery to implant a lap-band -- a silicone ring fitted around the upper stomach to suppress appetite -- last June 5 at a surgical facility in Beverly Hills operated by Top Surgeons, the sponsor of those 1-800-GET-THIN and 1-800-GET-SLIM billboards that have become as inescapable on Southern California freeways as smog in summer. He was sent home to Perris with a prescription for oxycodone painkiller and instructions to return in a week.

Three days later, Brooks was dead. At the autopsy, a Riverside County coroner found stomach contents leaking around the edges of the lap-band and more than a liter of pus in his abdomen. On her report she listed the cause of death as "peritonitis due to lap-band procedure due to obesity."

Read more here:

http://www.latimes.com/business/la-fi-hiltzik18-2010apr18,0,3957577,full.column

***EDIT*** 2/18/11 A FORTH Lap Band patient has died as a result of this clinic. Yes, folks... that is FOUR people, dead, due to the actions of these doctors. Please read the following article:

http://www.chicagotribune.com/topic/la-fi-lap-band-20110211,0,1272514.story?track=rss-topicgallery


5/10/10

Dr. Christine Ren of NYU has admitted altering medical records to hide the fact that she and her husband, Dr. George Fielding, were using unlicensed physicians in the operating room and for follow up care of WLS patients. It is thought that this is one reason one of her patients passed away (her Med Malpractice paid out $973,000 to the estate of the patient). Dr. Neelu Pal, the doctor that was the whistle blower is currently suing because Drs. Ren and Fielding were able to get her fired for telling what she knew.

See more here:

http://www.nypost.com/p/news/local/manhattan/fat_in_the_firing_for_rex_doc_Xk1P6kDfm3HcaGJ6j87X1L
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4/15/10

Please be aware that Dr. Jacob Joffe, previously a licensed surgeon in Canada, has moved to Mexico and is practicing there. He has a long history of sexually assaulting his bariatric patients.

http://www.ambisurgery.com/about-surgeons.php

http://www.weightlosssurgerychannel.com/breaking-wls-news/bariatric-surgeon-hospital-hit-with-class%E2%80%90action-suit.html/

Don't be a victim!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4/10/10

Please be aware of a clinic in Tijuana, Mexico (MISTER Betancourt) that has been harming people left and right. As of this writing in the last six months they have had over 50 infections, over 10 staple line leaks, perforated stomachs, spleens, and livers. These are more complications than most surgeons have in an entire career.

They claim to be a licensed hospital. They are an unlicensed clinic. They recently "purchased" a license from the Mexican government, as Mr. Betancourt boasts.

They claim the owner is a Medical Doctor, he has yet to even finish Jr. high school.

They claim the surgeon, Almanza, is board certified in surgery, he is NOT board certified in surgery.

There are fantastic surgeons in every country and there are butchers in every country. The US is no different and you are not assured of having a safe surgery merely by staying in the US. I do not care if you have your surgery in the US, Mexico, India, or in outer space - research is key. Do not ignore the bad because the price is right. This is your life and you owe it to your family to go to an experienced, skilled surgeon that has earned a positive reputation.

Sandy Johnston is a big promoter of Hospital Jerusalem, aka Mr. Betancourt, aka Betancourt Medical, aka Mt. Zion aka Emmanuel. She will try to talk you into surgery with a dangerous surgeon. She makes around $1500 off your surgery if you go to Almanza. She has posted a fake medical license for Mr. Betancourt, she has claimed that Dr. Almanza is board certified in surgery (he is not), she has claimed that in Mexico things are done differently, if you want to be board certified you pay a website and you are board certified. This is not accurate. To be board certified in Mexico you do it exactly like in the US, you pay a fee to take a test, if you pass the test you are board certified.

She attempts to discredit my push to do your research by claiming I am a coordinator and that I only push my doctor on various weight loss boards. If you will see my posts I don't recall ever starting a thread about my doctor, the only time I discuss my doctor is when specifically asked, and when asked who is good I offer three names of doctors I would personally be willing to go to in Mexico, not one.

For the past few months she has claimed to many people via PM and phone calls that she and I are in federal court in litigation. This is flat out - a lie. I live in Mexico, if we were in federal court wouldn't she be somewhat aware that I don't even live in the United States? She was unaware I was living in Mexico when she was making these bogus claims. It was another attempt to discredit me for pushing YOU to do your research before having major surgery in any country.

My question for Sandy would be this, why does Sandy try so very hard to discredit someone encouraging that you research your surgeon instead of just trusting any coordinator to tell you what you need to know? A coordinator's job is to sell surgery. Period. (Think 'used car' salesman.) If you do not have surgery through the doctor they are pushing, they do not make money. If the surgeon they work for is so great, why the push to discredit someone encouraging research?

I do not push any one surgeon, I do push research, it is pretty much my mantra.

Sandy Johnston is not honest about Dr. Almanza, Mr. Betancourt, or me. I have let this go for far too long, now I am speaking out.

Do your research.

What I Learned About Surgery In Mexico

What I have learned about surgery in Mexico:

When Dr. Campos asks if you are doing your trippy little breathing exercises, telling him you are is of little value when you can't quite recall what you did with the machine. He will find it for you and watch you actually use it.

Ditto on the breathing machine with Dr. Aceves.

Feeling pride - to the point of boastful - of your Spanish skills when telling the nurse you would love nothing more than to run outside for a cigarette actually translates into: I just smoked a cigarette inside the hospital and I'd like another, please. At least that is how they understand it. I'm quite sure my Spanish is better than those from Mexico.

Pointing to your stomach and saying, "Ouch ouch ouch," is medical Spanish for "May I have pain meds, please?" Clutching your gut and gagging is medical Spanish for, "I'm gonna hurl, I have something for nausea please?"

Pain meds do not taste like candy. Nurses fib.

Feeling pride that you finished your crushed tablet and water is short lived. Nurses belong to the clean plate club. They will look and see there is tablet residue on the bottom of the cup and pour more water in there so you can enjoy it a 2nd time around. Having the expression of a 4 year old that just ate spinach while drinking crushed tablets and water will make the nurse laugh.

Quality doctor/patient time is done by sneaking outside the hospital to grab a quick cigarette. You see, Dr. Aceves finds smoking most annoying and this behavior leads to a variety of lectures ranging from slow healing, health issues, etc. Just look at him wide eyes and nod like you are learning something new!

Trying to explain going outside by telling any of the medical staff that you are merely trying to get some exercise is fruitless. They won't buy it.

When you wash your hands and accidentally drop the paper towel you used to dry them, you naturally bend over to pick it up and throw it in the garbage. When you get halfway down to pick up the paper towel you discover it is much easier to kick it in a corner.

Feeling guilty about kicking the paper towel in the corner leads you to kick it over to the couch like a dodge ball, sit down, and SLOWLY bend over to pick it up. Of course, this means you must stand up again and walk to the garbage. Since your suitcase is on the couch within reach you throw it in there and decide to call it a souvenir from Mexico.

Sleeping on your side is tricky business. It takes a few moments to slowly turn to your side while muttering damn damn damn due to discomfort. You finally lay on your side, clutching the pillow to your stomach. You are blissfully comfortable, sigh a sigh of relief, and without fail Dr. Campos will walk in and want to see your incisions. This is guaranteed to happen 100% of the time. Matter of fact, I am convinced this is how to get Dr. Campos to come to your room. If you have a question and would like to see him there is no need to request a nurse contact him. Merely take the time to turn on your side, mutter damn damn damn due to discomfort, get *really* comfortable, and within minutes he will come to your room and you can ask your question.

As soon as he leaves you slowly repeat the process. Turn to your side, mutter damn damn damn, get comfy and Sergio will come in wanting to see your sutures.

When the folks that had surgery the day before you come in to check on you, don't mess with them because I am here to tell you, these people mean business. Before you know it the gauze version of TEDS hose on your lower legs is suddenly removed and you discover your butt is hauled out of bed and you are doing laps up and down the hallway dragging your IV pole with you. The day old bandsters will cheer you on. Just remember, tomorrow it will be your turn to play "day old drill sergeant bandster," to the newbies.

Your first poop will hurt. Deal with it.

Experience is a wonderful teacher. When it's time for your 2nd poop you think it through and decide you can wait for another day.

When you accidentally bust open and clot off your IV in front of Dr. Aceves - suggesting to him that you, the patient, remove the IV it is not an option.

When the real newbies are there the day before their surgery for labs, xrays, etc., it's a fun time to show off your incisions. They actually WANT to see them unlike the rest of the free world.

The idea of broth and orange jello for breakfast is something met with anticipation. It almost borders with excitement when you see the nice lady from the kitchen with your tray.

If you thought you had a Buddha belly before surgery, check it out after surgery. The gas they use to blow up your belly is still there. You actually wonder, when you finally start burping will it sound like you just inhaled helium as you speak?

When Dr. Campos asks you if you are passing gas it is a toss up trying to decide if you should remind him that is not a question one asks a lady or if you beg to know when you actually WILL fart/burp up a storm. Your gut looks like if you get near a sharp pointy thing it will pop like a balloon.

Glue is a funny thing. The medical staff will tell you that they put a plastic film (much like saran wrap) on your stomach before surgery. It's a 'clean' issue. They are not telling you the truth. When you are having surgery they pour epoxy all over your stomach and later, when you shower you realize it will never come off. It is there for life and you question if it will tan with the rest of your skin the next time you lay in the sun or if it will be blotchy and yicky. The real secret... if you look at it carefully you will see the logo of Almater hospital in the permanent glue.

I double dawg dare you to lean against something with the epoxy on your stomach. You'll be stuck to what you are leaning to like strong Velcro. Prying your epoxy covered gut off the counter you just leaned against to wash your hands is similar to prying apart two of the strongest magnets that you have ever experienced. Much weight loss is accomplished this way as your skin is still stuck to the counter. I estimate 4 pounds.

The day after surgery - if you discover the epoxy on your stomach has formed mini glue balls under your breasts you realize it's time for a breast lift.

Much bottled water, ice, broth, tea, Jello, juice, and IV fluids. Guess where you will be spending time between laps through the halls and naps?

Viva la Mexico!!!!!!!

Is Weight Loss Surgery For You?

If you are here you are likely either thinking about WLS or you have already had WLS. Either way, you are in the right place.

I think most obese folks consider WLS and due to the unknown we tend to fear it. Everyone knows someone *or* knows someone that knows someone that had serious complications including possible death from WLS. WLS isn't as scary as it sounds, to be honest obesity carries more risk than the surgery itself. We tend to get used to the risks associated with obesity but surgery? Not so much. We don't worry as much about high blood pressure, diabetes, sleep apnea, joint damage, heart disease, dialysis, and all the other complications that go with obesity but the fear of surgery scares many away. This is not acceptable, surgery is safer than obesity!

You have probably tried to lose weight before, right? Are you still trying? Please tell me in detail how well you are doing with this task? Some can lose weight but they cannot keep it off. Others are unable to lose weight to begin with. This is NOT your fault! Obesity is a disease, it is not a character flaw. Recent studies coming out of Canada are showing that doctors who suggest traditional diet and exercise for weight loss in the obese are seriously under-educated about this disease and if they understood what they believe they know, they would realize the chances for our losing weight on our own are close to zero percent. Old studies show those who are obese and diet and exercise their way to a healthy BMI make a whopping total of 4% of us. New studies indicate that is 0%. I will post this study elsewhere.

Jenny Craig, Weight Watchers, meals delivered to your home... do you know what all these have in common? They all survive on repeat business. Stop and think about how many people you know (including yourself) that have tried these? Many lose quite well. Kirstie Alley comes to mind. She did very well but as soon as she stopped the program she regained her excess weight and maybe added a few pounds on top of that. These programs survive on repeat business, people lose well, stop the program, regain, and return to do it again. Is this really productive?

WLS isn't a sin, obesity isn't a sin. It isn't a character flaw either. It is a disease. It's time we all start treating it as such. Being obese is not a horror, staying obese is a horror and especially if you have options. Where there is a will there is a way.

Typical feelings we have about ourselves is a lack of discipline, a lack of self control. A lack of self esteem is common. I will cop to them all! I just didn't have what it took to do it on my own. But then had I been diabetic I couldn't have treated that on my own without medical intervention either! We often times start hating ourselves, our lack of ability to lose weight, we don't like the way people look at us, we don't leave our homes, self loathing. It's all a part of what we go through.

Surgery does not cure everything but it sure gives all of us an opportunity to start a new life with improved self esteem.

Take a chance, get your life back!

What Is A BMR? (Basal Metabolic Rate)

What is a BMR? A BMR is your Basal Metabolic Rate. It basically means if you stay in bed all day and do virtually no exercise, how many calories does it take to maintain your body.

When I was at my biggest of 252 pounds my BMR was 1,850, or in other words the calories needed for my body to keep my heart beating, my brain functioning, my lungs breathing was 1,850. The bigger your body the more calories it takes to maintain that weight.

When you lose weight your BMR goes down so it takes fewer calories just to maintain. Today my BMR (considering I am a few years older and a lot of pounds lighter) is 1,262.

So for comparison purposes---

252 pounds I needed 1,850 calories just to maintain my weight.
120 pounds I need 1,262 calories just to maintain my weight.

If you add exercise to the equation then I need more calories just to maintain my weight. This is why the bigger the person the faster they lose in the beginning.

You can "kinda sorta" gauge how much weight you will lose in advance by knowing your caloric intake, the number of calories used to maintain your weight, and how many calories you are burning daily.

If each pound is worth 3,500 calories (and it is) and my BMR is 1,850 calories, then we have the following:

3,500 - 1,850 = 1,650

So this means that if I just eat enough calories to maintain my weight I should lose about 1/2 pound of weight daily. Add exercise to the mix and I'll lose even more.

This is not an exact science, this is an estimate. Your metabolism is not the same as mine and my metabolism is not the same as your mother's. We are all different.

Here is a calculator to measure your own BMR:

http://www.bmi-calculator.net/bmr-calculator/

At the same token when you are bigger and you walk on your treadmill at 2 miles per hour for 30 minutes, you are going to burn MORE calories than if you weigh 100 pounds less and do the same exact exercise. This is why the closer you get to goal the harder it is to lose those last few pounds. It takes more calories for a bigger body to walk 2 miles per hour for 30 minutes than it does for a smaller body to walk 2 miles per hour for 30 minutes.

Make sense?

What Is A BMI? (Body Mass Index)

What is your BMI? Simply stated, it is your body fat based on height and weight.

I am 5' 5" and at my highest I was 252 pounds or a BMI of 41.9. Today I am 5' 5" and I weigh 120-125 for a BMI of 20.0 - 20.8.

The reason the medical community uses BMI is because weight alone doesn't really tell us much. My sister is much taller than I am so if I weigh the same as she does at a healthy weight for her, it would be overweight for me. If you figure that 160 pounds is a healthy weight for her, that would make me overweight because I am so much shorter than she is.

To calculate your BMI multiply your weight in pounds and divide that by the square of your height in inches. Or, make it easy on yourself and use a BMI calculator:

http://www.nhlbisupport.com/bmi/

What is your BMI? Where does it fall within the following:

Less than 18.5 = Underweight
18.5 - 24.9 = Healthy or normal weight
25.0 - 29.9 = Overweight
30.0 - 34.9 = Obese
35.0 - 39.9 = Seriously Obese
40.0 - 49.9 = Morbidly Obese
50.0+ = Malignantly Obese or Super Obese

Now, with the above written I must tell you that the BMI chart is not a one size fits all. Not everyone falls within the standard BMI figures. Let's take a body builder for example. They may not have an ounce of fat on their body but their BMI may show overweight or even obese! It's not fat, it's muscle and they are not overweight or obese. However, let's get real here. If you are reading this blog for you or on behalf of someone else they are not likely a body builder but simply written, they have too much body fat. That's okay, it's not a sin. It is not a sin to be overweight, it is a shame not to do anything about it and that is what this blog is all about. Recognizing where we are today and deciding what options we have to fix the problem.

It should be noted that if you are in the category of a BMI of 25 or greater, you are in the majority of the US population and many other countries. In the US today it should be noted that 1/3 of us are healthy weight, 1/3 of us are overweight and 1/3 of us are obese. But that's okay, it's not the end of the world. We have lots of options available to us and we all need to find the trick that works for us. The trick that helps us to overcome weight issues and get our lives back.

You Want Surgery, So Now What?

So now that you have chosen a surgery type, now what?

Now you need to research to see if your insurance covers WLS. Most people who have medical insurance do not have WLS benefits. If you have WLS benefits, count your lucky stars!

WLS benefits are covered under group policies only. Private policies do not cover WLS and the reason is that all the people (majority) who do not have WLS benefits would be buying private policies in order to have insurance companies pay for their surgery. As soon as their surgery was complete they would drop the policy. No insurance company could afford that for long. Thus, private policies do not cover WLS.

Group policies do cover WLS IF the WLS premium is paid. Let's say you work for a large company, your chances for having WLS benefits are good. Typically the larger companies will pay the additional premium for WLS. If you work for a smaller company it is unlikely you have the right benefits. Smaller companies cannot typically afford the expensive premiums. They cannot just cover one or two employees, it is all or none. Either they have to cover all employees or no employees.

Call your insurance company, ask if you have WLS benefits. Regardless if they say you do or you do not verify this with your own eyes. When you call your insurance company you are talking to a first level employee. They are not typically experts in insurance. Whether or not they claim you have benefits ask them to email you a link to your on line policy showing where WLS is included or excluded. Do not take their word for it.

If you do have WLS benefits ask them what you need to do to qualify for surgery. Most companies require part or all of the following:

A BMI of 35 or greater and very specific comorbidities such as high blood pressure where you need medications to control your disease. Borderline hypertension that is controlled by diet and exercise does not count. And/or, diabetes and no, prediabetes does not count. You must be a full blown diabetic on medications to control your blood sugar. Things like a family history of obesity, high blood pressure, diabetes, these do NOT count. Your insurance company does not care if your mother is diabetic or not, they want to know if YOU are a full blown diabetic.

Issues such as joint damage, back pain, headaches, PCOS, asthma, ... none of these issues matter. Well, they do to you but they do not matter to your insurance company in the least when it comes to qualifying for WLS.

If you do not have medical comorbidities such as the above you must have a BMI of 40 or greater.

Some insurance companies require you to prove through various types of medical records that you have had a BMI of 40 or greater for the last five years.

Some insurance companies require you to do a 3-6 month medically supervised diet. This means (usually) that you have to go to your nutritionist or physician every month for 3-6 months to be weighed and measured. Then your health care professional must document that they weighed and measured you and discussed with you diet and exercise. If you miss as much as one appointment your insurance company has the right to make you start over the entire medically supervised diet.

Many insurance companies require that you go to a nutritionist for an evaluation of your diet.

Many insurance companies require that you go to a bariatric surgeon to evaluate your weight.

Many insurance companies require that you go to a psychologist for a psych evaluation.

Many insurance companies require that have a sleep study done to see if you have sleep apnea.

Let's be honest here, they do not make this an easy process.

What if you do not have WLS benefits on your insurance? Well, welcome to the world of self pay. I'm not being snitty, I've self paid twice so I fully understand. Once for a Lap Band and again for a revision from band to sleeve. If you are in this position I can empathize with you. Please note, there are no organizations that will give you money for WLS. No doctors will do your surgery for free. They are asked on a daily basis and they would go out of business if they did free surgery, the costs associated with WLS are great in number. The cost of a Lap Band is $4,000 and that is just for the band. That does not include OR time, the anesthesiologist, medications, anesthesia, nursing, or all the other costs associated with surgery.

One of the many issues I have learned over the last four years is that if someone wants surgery badly enough, they will find a way to get it. Some save for years, some take from their childrens college funds. Some refinance their homes, some sell off personal items, some get 2nd and 3rd jobs to pay for surgery. People that want it bad enough find a way. It's a cold and harsh reality, yet true.

The next step is to find a doctor. Now, I realize this sounds odd. Most would have their surgeon help them pick a surgery type. That's fine as long as you go to a surgeon that does all the major procedure types. For example, let's say you want Gastric Bypass and you go to a surgeon that is a band mill, meaning they only do Adjustable Gastric Bands. They sell a product, their product is a Gastric Band. If you go there asking about a procedure they do not know how to do they are going to tell you the evils of all surgery types they do not do. Let's face reality here, doctors are in business to make money just like the rest of us. We all go to work to earn a living. Asking a band mill surgeon about Gastric Bypass is like asking a Toyota dealer to tell you all the best aspects of buying a Honda. They are going to push what they sell. Thing is... *you* are the person that has to live with your surgery type for the rest of your life. It is you that has to decide just what you can live with and what you cannot live with.

So either decide on a surgery type and then choose a surgeon that does that surgery or go to a surgeon that has no vested interest in which surgery you choose, you will get a much more balanced answer and more balanced suggestions to consider.

Please see "Researching Mexican Lap Band Doctors" on how to research your doctor, it will work for both US and MX surgeons. Please see "Researching Mexican Sleeve Surgeons" on how to research your doctor, it will work for both US surgeons and MX surgeons for sleeves and bypass. For DS the doctors are extremely limited and you should check on the www.DSFacts.com website for suggested surgeons.

If you have WLS benefits on your insurance get a list of all the doctors they contract with and start going to seminars. Remember, go to a surgeon that does the surgery type YOU want. YOU have to live with this surgery type for the rest of your life, don't let a surgeon talk you into the surgery type he performs instead of the surgery type you want. I promise you, you will regret it if you don't.

If you do not have WLS benefits on your insurance plan, or if you do not have insurance at all then you can go to any doctor you wish. Remember, medical tourism is a growing industry. Surgery is MUCH cheaper and equally as good (with the right research) outside of the US. I did it, lots of people do it. I went to Mexico for my band as well as for my sleeve.

Go to lots of seminars, meet the doctors (if in the US), get a feel for them. See which doctor you feel comfortable with. In some ways the most important issue is surgical skill but you know, unless you get a sleeve you'll need follow up care for the rest of your life. You really need to go to someone you like and trust as well. If you hate your surgeon you are less likely to go for follow up care and that will affect your weight loss.

There is such a thing as a Center Of Excellence or a COE. You will see this often on various WLS message boards. Please do not assume this makes the surgeon good. Some of the worst surgeons are a COE, it merely means the hospital they work out of meets certain requirements. It means absolutely NOTHING about surgical skill.

Choose a surgeon with lots of experience. There is a learning curve to every surgical procedure including removing toenails! Don't be the guinea pig, be the patient that goes to a good, experienced surgeon with great stats, lots of skills, and oozes compassion and understanding of obesity.

Now it is time to choose a surgery type and get your life back!

Which Surgery Type Is Right For You?

There are several surgery types but there are four that are the most popular. I'll start with the top four from least invasive to most invasive. Keep in mind, the less invasive the surgery the less weight you will lose, statistically. The more risk you have for surgery the more you are likely to lose.


*****If you take nothing else away from this section of my blog please understand one thing, there is NO surgery type that fixes white carbs. No surgery type will prevent you from absorbing sugar, flour, rice, or pasta. That one is on us to change, not the surgery. Surgery is just a tool for us to lose our own weight. We can have surgery to limit the quantity of food we eat, we can have surgery to prevent us from absorbing all the calories that we consume but no surgery type prevents us from absorbing every white carb we consume.*****


ADJUSTABLE LAP BAND

Inamed, Inc originally came up with the Adjustable band and later sold the rights to the Lap Band System to Allergan who currently owns it. This band was approved by the FDA for use in the US in 2001.

The band is a restrictive only procedure meaning that it will limit the quantity of food you can consume at one time but you will not malabsorb nutrition or calories.

The Lap Band System was originally approved in Mexico in 1991. The Mexican doctors are the surgeons that perfected the surgical technique used today. Mexican surgeons were also the primary proctor surgeons (Proctors train other surgeons in a given procedure or technique.) that trained US surgeons in 2001. They still proctor many surgeons in the US and other countries. An interesting side note is that when Inamed owned the Lap Band System they had more strict requirements to be a proctor. You had to have at least 100 bands under your belt and low complication/morbidity stats before you could train another surgeon. Since Allergan took over they only require that a surgeon has performed 10 bands before they can teach another surgeon. The reality is that proctoring has "dumbed down" to "watch one, do one" and this is unfortunate. In order to be Allergan certified you must be proctored by another surgeon. When Inamed owned the rights to the Lap Band they would revoke a certification if the doctor proved to have a higher than normal level of complications. When Allergan took over they changed the policy, returned certifications to all surgeons that previously had high complication and morbidity stats. My personal opinion? They just want to sell bands and lots of them.

Johnson and Johnson decided they wanted a piece of the pie and their band, the REALIZE band was approved by the FDA in 2008. They claim big differences between REALIZE and Allergan Lap Band System but to be honest? They both work about the same way. The significant difference for patients is the port. I don't care for port placement of the REALIZE band but the Allergan is taller and tends to stick out more at goal.

About the band...

The band is a silicone band that goes around the upper part of your stomach creating a pouch. Your stomach takes on the shape of an hourglass. The whole idea is that you eat filling the upper pouch of your stomach and you can get full on a small quantity of food. There is a narrow pass through from your upper to lower stomach, it takes time for food to drain from your upper stomach to your lower stomach. There is a nerve at the top of your stomach called the Vegus nerve. This is the brain of your stomach, it basically tells your brain when you are full. So, you stay full on a small quantity of food for an extended period of time.

Three advantages of this surgery:

1) Least invasive
2) Removable
3) Up front surgery fees are more affordable than other surgery types

Three disadvantages of this surgery:

1) Slowest weight loss, least weight loss, highest regain, most mechanical problems of all main surgery types
2) Maintenance for life, hard to find follow up care if your surgeon moves, retires, etc.
3) Very high complication rate and costly for self pay folks


VERTICAL SLEEVE GASTRECTOMY

The VSG is a restrictive only procedure meaning that it will limit the quantity of food you can consume at one time but you will not malabsorb nutrition or calories.

The VSG (aka Sleeve) is where your surgeon will surgically make your stomach smaller. Your stomach has an elastic portion called the fundus. The fundus of your stomach can hold 18 cups of food. Clearly, this is not a benefit to those trying to lose weight. In the sleeve procedure your surgeon will remove the outer curvature of your stomach leaving a small, banana shaped portion of your stomach.

Studies show that obese people tend to produce three times the amount of Ghrelin as a naturally thin person. Ghrelin is a hormone that is mostly (but not all) produced by the stomach and Ghrelin is what tells your brain that you are hungry. People with the sleeve tend to lose the majority of their hunger. Doctors are not in agreement if Ghrelin will return later in life. Quantities of food vary from surgeon to surgeon but theoretically when your sleeve matures in 4-6 months you should be able to eat about 3oz of solid, dense protein such as steak or about 6oz of soft foods such as cottage cheese.

There is a bit of history with the Sleeve procedure. It used to be part one of a two part procedure. Today it is used as a stand alone procedure. If someone has a very large BMI they are often times too high risk for a full Gastric Bypass or DS surgery. So traditionally surgeons have performed a sleeve procedure and sent the patient home to lose enough weight to make a riskier and longer procedure safer. Later they come back and have the malabsorption added to their surgery type. Today they are making smaller stomachs and not doing the malabsorption for those that merely want restriction alone. The procedure itself is NOT new, what is new are the weight loss statistics since it was previously used as part one of a two part surgery.

There is a chance of a vitamin B12 deficiency. Your stomach produces an enzyme called Intrinsic Factor or IF. IF is needed to absorb Vitamin B12 via the stomach. Some people produce less IF after surgery and they need to take Vitamin B12 under their tongue instead of swallowing a tablet.

Three advantages of this surgery:

1) Safest surgery LONG term of all WLS types
2) Drastic reduction in hunger due to removing the portion of the stomach that over produces Ghrelin
3) No maintenance, no aftercare

Three disadvantages of this surgery:

1) Not reversible
2) Less than 1% additional *surgical* risk over the Adjustable Band
3) Risk of B12 deficiency


ROUX-EN-Y aka - GASTRIC BYPASS aka - RNY

Gastric Bypass is considered the Gold Standard for WLS in the US. Many believe the Adjustable Band and Gastric Bypass will be considered "yesterday's procedures" and the VSG and DS will be tomorrow's procedures due to better weight loss and improved resolution of comorbidities. This topic is under debate by both surgeons and patients. But the fact remains that the Gastric Bypass procedure is probably the most common surgery performed today in the US.

This is the preferred method of performing gastric bypass surgery. In Roux-en-Y, your stomach is stapled to create a small pouch and a passage for food to go around (bypass) a section of your small intestine.

A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower "remnant" pouch and then re-arranges the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different GBP names. Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food. The long-term mortality rate of gastric bypass patients has been shown to be reduced by up to 40%; however, complications are common and surgery-related death occurs within one month in 2% of patients depending on the target group being studies. Bottom line is the larger the patient and the more illnesses (comorbidities such as high blood pressure, diabetes, etc.) the higher the risk due to the invasive nature and length of the surgery.

This surgery type is ideal especially for Type II diabetics and those with uncontrolled reflux (GERD) not caused by a hiatal hernia or obesity.

The problem with this surgery type is that the stoma (pass through from pouch to small intestine) can dilate in as much as 1 in 5 patients. This causes a complete lack of restriction 2+ years post op. The stoma is designed to keep food in the pouch to provide satiety for several hours after eating. If the stoma dilates, or stretches, there is nothing holding food in the pouch and the patient tends to feel hunger all the time. Since Bypass folks only malabsorb calories for 6-24 months, if their stoma dilates they are hungry all the time and 3 years post op they are no longer malabsorbing calories... the regain starts.

Many believe that Gastric Bypass is not reversible. Theoretically it is totally reversible. This does not mean you should go into this thinking if it does not work you can always have it reversed. It is a huge and major surgery to try to reverse and it cannot always be done. Many believe the surgery is not reversible because intestine is removed. Intestine is not removed in this procedure, it is bypassed thus the name, Gastric Bypass.

For every 120cm of small intestine bypassed people tend to malabsorb about 33% of calories. This is not a permanent feature. We all have something in our intestines called villi. Villi are responsible for absorbing fat, calories, and nutrients. The body has an amazing way of compensating for alterations we choose to make. Within about 2 years the body creates more villi to absorb fat and calories and the patient will never absorb nutrition properly again. Nutrients are absorbed in very specific parts of the intestine, for example iron is absorbed directly under the pyloric valve (the part of the stomach that controls how fast the stomach is emptied to the small intestine, this is bypassed in RNY folks, btw) and this part of the intestine is bypassed so you will need to take supplements for the rest of your life to make up for this. If you cannot or will not take supplemental protein, vitamins, and minerals and if you will not agree to have vitamin labs done at least annually you should NOT have this procedure.

A Welsh study recently announced that 85% of the time within 10 days of surgery patients are in full remission of Type II diabetes. This is significant in the sense that it is changing the way science is approaching diabetes in prevention as well as treatment.

Three advantages of this surgery:

1) Ideal for Type II Diabetics and those with uncontrolled reflux not caused by a hiatal hernia or obesity
2) Fast weight loss the first year especially for insulin resistant people such as PCOS patients
3) Dumping - some consider this to be an advantage, some consider it a disadvantage. For about 1/3 of bypass patients if they consume high sugar or high fat foods they "dump" and for many this keeps them on the straight and narrow, it keeps them from eating foods that are not ideal for weight loss.

Three disadvantages of this surgery:

1) Significant morbidity rate for very high risk patients
2) Ability for the stoma to dilate causing increasing hunger and weight regain
3) Side effects such as reactive hypoglycemia, possible seizure disorder, vitamin deficiencies, and necessity for labs annually for a lifetime. When this surgery works well it works very well. When complications happen they can be quite serious.


DUODENAL SWITCH aka DS

In this procedure, the surgeon removes about 80 percent of the stomach, forming a thin sleeve-like stomach. The valve that releases food to the small intestine remains (duodenal switch) along with a limited portion of the small intestine that normally connects to the stomach (duodenum). The surgery bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach (biliopancreatic diversion). This weight-loss surgery is effective but has more risks, such as malnutrition and vitamin deficiencies, and requires close monitoring.

This is a procedure that is nice in the sense that the first half of the surgery is a Vertical Sleeve Gastrectomy and the second half is the DS, or bypassing of intestine. There is no concern for dilating a stoma as in Gastric Bypass and the long term weight loss is the best of all surgical procedures. But as explained earlier, the thing about WLS is that the less the risk, the less the weight loss. The greater the risk in surgery the greater the weight loss. This is the greatest risk of all surgery types for malnutrition and various vitamin deficiencies yet it provides the best long term weight loss stats. It does not have "more" complications than Gastric Bypass but if complications occur, the complications are greater in nature.

By the time you have this procedure you will not absorb 80% of fat, 50% of protein, and a handful of complex carbs. A high fat diet is not only permissible with this surgery type, it is necessary.

One down side to this surgery types more-so than other surgery types is that if you consume a great deal of white carbs such as flour, sugar, rice, or pasta you will have gas that is not pleasant to the nose. This happens with RNY as well but not to the same degree.

Not all surgeons can do this surgery type. It requires a skill as well as an art, much experience is necessary to perform this particular surgery safely and effectively. For detailed information please see the following website:

www.DSFacts.com

They can do this surgery type far more justice than I can.

Three advantages of this surgery:

1) Best weight loss and best long term weight loss stats of all surgery types
2) Not only the ability but the necessity for the patient to consume a very high fat, high protein, low carb diet
3) A more normal stomach than bypass, there is no pouch and no stoma

Three disadvantages of this surgery:

1) Highest risk surgery type
2) Highest risk for vitamin and mineral deficiencies
3) Not appropriate for vegetarians or vegans or those unable to comply with a high fat diet


There is another procedure type, it is one I cannot suggest to anyone for any reason:

MINI GASTRIC BYPASS aka MGB

This was the original bypass procedure and due to bile leaking into the stomach and esophagus (causing SEVERE burns) ALL the better surgeons stopped doing it in the 1970s. It is merely dangerous and only the bottom-feeder surgeons even do this procedure. It is technically easier to do than RNY or full gastric bypass but due to the danger to the patient none of the skilled doctors with good reputations will do it.

GASTRIC SLEEVE PLICATION aka GASTRIC IMBLICATION, aka Plication

This is a new procedure, as of this writing the best long term stats are only 18 months old. It is similar to a sleeve but instead of stapling and removing tissue it requires sutures instead to create a sleeve shape. No part of the fundus is removed.

It is restrictive only and not malabsorptive.

Three advantages of this surgery:

1) No risk of a staple line leak however, there can still be a leak from perforating the stomach.

2) There is no tissue removed (This creeps out some people who are considering the sleeve.)

3) It is done by lap instead of full open incision surgery.

Three disadvantages:

1) It will be extremely difficult to revise to anything else but DS if it does not work and it is unknown if it will work because there are no long term stats available.

2) Reflux is much more significant for this surgery type vs. the sleeve. Unfortunately, there is little to do to resolve this if meds (PPIs) do not help.

3) The sutures can give way over time and the stomach would be larger thus the person could eat more. Speaking of sutures one of the dangerous aspects of this surgery is the blood supply in the stomach. The stomach has a rich blood supply and many large blood vessels on the left side of the stomach. When the plicated stomach is folded in and sutured it can potentially cut off the blood supply and the stomach tissue will die and become necrotic. This can happen immediately post op or months down the road.

****NOTE NOTE NOTE****

8/17/11

As of this writing the doctor who originally created this surgical procedure was at a Germany Bariatric Conference within the last week and he strongly advises physicians to explain this procedure is a temporary weight loss procedure that is not expected to give long term results. It is sill investigational and his own 3 year stats show significant regain at the 3 year point post op. The creator of this surgical type does not suggest this surgery for long term weight loss.

VERGITO

More info and animation coming soon. If you want to see an animation of the procedure please visit Dr. Husted's website, he is the only surgeon in the US that does this procedure: http://johnhustedmd.com/


Now it is your job to determine which surgery type is right for you. First you consider if you want restrictive only (Bands/Sleeves) or if you want Restriction AND malabsorption (Bypass/DS). The greater the risk the better the weight loss and long term regain stats. It's a trade off, whatever you think is right for you.

Remember, if a doctor can only afford to advertise on www.youtube.com, it might behoove you to look elsewhere for a more skilled surgeon.

Fat Folks Are Wise Folks

I have a dream.

You see, I am in medicine and I have been working with all kinds of patients for more years than I can to admit. Anyone in medicine, a policeman, or a fireman... they can all tell you that they live vicariously through their patients/prisoners. We don't always have to have a disease, go through an experience, or do something stupid to learn. We can learn through others. I am convinced that retired nurses are bored to tears, they are no longer living life through others. They need the challenge and the lessons. I remember walking into a room of seriously mentally ill folks and "feeling" what they were feeling and to be quite frank, it scared the hell out of me. I could zone into the person I was connecting with. I got it, I understood. I didn't like it - not even a little. I would never want to experience that for the rest of my life. But, I did have the opportunity to experience it for a few moments.

A friend of mine is a nurse and she still relates a story from her own "care home" days. She had a mentally ill young patient that was bare butt nek'ed on the front lawn on her hands and knees mooing like a cow. Now seriously, how many of us have seen such a sight? I had a patient that drank so much water (it's called water intoxication syndrome) that he aspirated the contents of his stomach and drowned in his own water. He died at 31. I had another mentally ill patient that probably taught me more than I'll ever know in my whole lifetime with her one experience. She was a paranoid schizophrenic. I was working late one evening in my office and I heard some strange noises and left the safety of my office to see what the noises were. It was Margene, my patient. She was outside, curled up in a fetal position rocking back and forth making primitive noises. I sat down on the ground with her and asked her what was wrong? Was she in pain? She said she had just been gang raped. The reality was that she had not been gang raped on a pool table (we had no pool table) but the voices she heard 24/7 convinced her she had. It was that moment that I realized just how real these voices she heard were. She *believed* she had been gang raped and she was going through all the emotions that someone who really had been gang raped would go through. It was that moment that I realized, I get it. I really get it.

Obesity is not really a lot different in terms of lessons. We learn things we would never learn otherwise. Obesity isn't such a bad thing. STAYING obese is a very bad thing but going through the weight loss journey... not so bad. Sure, it's hard. But we learn things we wouldn't "get" otherwise. If someone would have told me this before I got to goal - I would have laughed at them and told them they didn't have a clue. It wasn't until I got to goal that I really fully understood. It IS worth it. If we are on this earth for nothing else it is to learn and you can't help but to learn as a fat person getting to goal. You learn about yourself and more important, you learn about the world around you. You learn about the issues of others. You "get" it, you really really do! Lessons you could not possibly learn through another, you learn through your own experiences.

I have a dream. My dream is to be a little old lady sitting in my rocking chair clicking my nails on the arm rest while on my front porch. You see, all the little neighborhood children will come to my front porch and hear my really cool stories. Everything, everything from my career to the ability to have a kind of compassion for people I would have never had, had I not been fat at one time.

It's not all bad. Obesity is a disease - it's not a character flaw. We learn to fix our disease. We learn from our disease. California beach blondes twirling their hair and rolling their eyes at us fatties... they will never get it. They will die uneducated. We are a different group, we will die a compassionate and intelligent group of people.

Finding a Surgeon - How?

There is just so much to write here. So much!

If your insurance is paying for your surgery the first thing is to determine your surgery type. The second thing to do is to find out who your insurance company contracts with and get that list. Go to every seminar for every doctor. Avoid the band mill type places, find a doctor that does all the major surgery types. If you want Gastric Bypass and you go to a surgeon that only does lap bands do you really think that doctor is going to try and sell you bypass? Of course not.

Doctors put on seminars for one reason and one reason only. To sell themselves to patients. They are not doing these seminars for your benefit, it is a method to give the same lecture to a group of people. It's a method of advertising. The doctor is selling his service, in this case Weight Loss Surgery. He is not going to use an expensive mode such as a seminar to talk you into going to one of his competitors.

Doctors are in business to earn a buck, that's okay. That is the profession they chose just like you chose the profession you practice. There is no rule that says a doctor cannot earn his living practicing his trade. But the bottom line is it is still a business and run like a business. The doctor is just like the car dealer, a Toyota dealer is not going to encourage you to buy a car they do not make, they are going to encourage you to buy a Toyota. A Band doctor is not going to talk you into Gastric Bypass if he does not do Gastric Bypass. He is going to emphasize all the good parts of the surgery he does do and brush off the procedures he does not do. You would do the same in his shoes.

This is why you choose a surgery type first and then you choose a surgeon. YOU are the person that has to live with this surgery type for the rest of your life, make it the right surgery type for you, not the surgery type that is in the best interest of your doctor's bank account.

So you have insurance (those without insurance or without WLS benefits on their insurance plan will be discussed further down.) and you need to find a surgeon. You have picked out your surgery type and you have a list of the doctors that contract with your insurance plan. You have ruled out the doctors that do not do your surgery type and you have gone to their seminars.

Do you need to *like* your surgeon or is it more important that his surgical skill is tops? Well, the answer to that is both. There are so many surgeons out there that want a piece of the bariatric money pie that there is little need to go to someone that is really nice but lacks in experience or skill. There is also little need to go to someone that is great in surgery but is a butt in his office. You have a right to both. The reason you want a skilled and experienced surgeon that is someone you like and respect as a human being is because if you have any other surgery type than a sleeve, you will be getting to know your surgeon well. All surgery types except sleeves require a lifetime of aftercare. Bands need fills and various check ups, Bypass and DS need labs for life. Now, with that said many bypass and DS folks do have their PCP do annual labs but if those labs are not up to par it is typically the bariatric surgeon that changes the vitamin regimen. If you do not like your surgeon you are not likely to go for follow up appointments and you are not likely to be honest about concerns and medical problems, weight loss or weight gain. So it really is important to find a surgeon you can be honest with, share personal thoughts and feelings, and overall just someone you feel comfortable with.

NO BARIATRIC COVERAGE ON YOUR INSURANCE PLAN OR NO INSURANCE AT ALL

Welcome to my world, the world of self pay.

Most people do not have WLS coverage even if they do have insurance. Most have insurance through an employer and it is the employer that needs to pay an additional premium on top of major medical for WLS benefits. With the economy today people are lucky to have basic insurance. Employers are saving money anywhere they can and sadly, that includes WLS premiums. It is not the insurance company that isn't offering it for group plans, it is the employer who can't pay the expensive premiums.

Private policies typically do not cover WLS for reasons explained earlier. So the bottom line is that we have a lot of people that have no insurance or they have insurance and no WLS benefits. They are self pay. If they do not have access to Medicaid or Medicare, and their insurance does not pay they are left with self pay. The downside to that is they are self pay, the upside to this is that they can virtually go to any surgeon they want and - in any country. I'll discuss that later in a section for Medical Tourism. But for now we are looking at US surgeons.

So you now have decided on a surgery type, you have obtained a list of all the bariatric surgeons on your insurance plan, you have ruled out all those who do not do your surgery type, and you have been to their seminars. You have ruled out those that give you the heebie jeebies, those that are so arrogant that you can't stand being in the same room as they are, doctors that do not answer questions in a way that makes you feel like you are walking away with more knowledge than you walked in there with, and you have narrowed your list further. Now what?

Now you start your research.

Sit down and make a list of things you require of your doctor and a list of things that you prefer in a doctor. For example, it might be something like this:

I require from my doctor:

1) FACS affiliation
2) ASMBS affiliation
3) A minimum of 500 (name your surgery type) procedures
4) A hospital instead of an outpatient surgical center
5) An office staff I can deal with and tolerate
6) (List your requirements)

I PREFER my doctor have:

1) A location reasonably close to my home (depending on surgery type this may or may not be possible.)
2) A nutritionist on staff vs. at a different location
3) A psychologist on staff vs. at a different location
4) ALL aftercare included in the cost of surgery (Get this in writing)
5) Support groups held weekly/monthly
6) (List your preferences)

This allows you to narrow the list down further.

Myth Or Fact?

All doctors are ethical and would never lie about affiliations? What do you think?

It is a MYTH. Many doctors will claim affiliations they do not really have. In order to be FACS one must meet very specific requirements. Many doctors will claim this affiliation but it's not true, they keep the affiliation until www.FACS.org catches them and requires they remove these letters from the end of their name. ASMBS is the same.

Doctors also claim that they have performed many more surgeries than they really have. This one is very hard to verify one way or another. I know of one Las Vegas surgeon that claims hundreds and hundreds of sleeves but as of today's date he has done a grand total of "3" sleeves. Yes, three. Yet when you call his office the staff will claim hundreds and hundreds of sleeves AND this doctor is a Center of Excellence. Scary, right? It is scary.

MYTH OR FACT?

You cannot verify all doctors for FACS or ASMBS affiliation.

MYTH. You most certainly can verify this information.

www.FACS.org

And:

www.ASMBS.org

Just go to the websites and do a search of your doctor, verify what you are being told is truth.

Please remember, the doctor will have a coordinator. It is his/her job to sell you surgery after the seminar. Sometimes they will tell you anything you want to hear just to sell you surgery. Yes, they will lie.

The bottom line here really is to know how to verify what you are told and NOT to believe everything you are told just because it comes from the MD office.

You should also get about 10 references for these doctors. Notice, I did not say you should get references FROM these doctors, I wrote to get them FOR these doctors. If you ask the office staff for 10 references you know full well they are going to give you patients that are thrilled to death and never had a problem. You need to find your own references. Go on various boards, find people that tend to be a bit quiet and shy. You see, there are a LOT of patient coordinators posing as patients on various message boards trying to recruit patients to their offices. There are not many doctors that use this method, but they are pretty easy to find. They invite each person to go to their doctor, only their doctor is the best, they cannot suggest anyone else in the whole wide world other than their doctor. Stay away from those folks. Find people that suggest several doctors, people that the majority of their posts are NOT about their doctor. Contact them and ask if you can talk to them on the phone.

There is a reason I suggest you talk to them on the phone. I recall when I was researching for my own surgery, one of the doctor's offices that I called I requested 10 references. They gave them to me and I contacted each one by email. All had wonderful things to say about the doctor. Real or fake? Fake. Upon looking at the IP address for all 10 references it was the same. It was the same person with 10 email addresses.

I'm telling you, the world of bariatrics is a cut throat business and you really can't be too careful. This IS your health, your life, and your future, take the time to do the legwork. Be paranoid, assume everything you are being told is a lie. Verify everything for yourself and take nobody at their word. These are businesses trying to survive in a bad economy, it's not just used car salesmen that are less than honest, it's many people and many businesses.

Does this mean every doctor will lie to you? Of course not, most will not lie. But the key here is that YOU do not know which are telling the truth and which are lying.

What about a death stat? What if a doctor has had a death? Does that mean he is a butcher that you should stay away from? Of course not. Not all deaths are the fault of the surgeon. Some people are *really* high risk and without surgery they will die. With surgery they are extremely high risk. What does a surgeon do? Refuse them a chance? Or take the chance?

Not all complications are the fault of the surgeon. A surgeon can give all the right pre op drugs to prevent blood clots but there is no promise that the body won't throw one anyway. Is that the fault of the surgeon or is that something that is sad but it happens?

What about leak stats? If a surgeon has had a leak does that make him a horrible surgeon? Not necessarily. Some leaks are the fault of the surgeon, some are the fault of the patient, and some are not the fault of anyone, they just happen. So what you are looking for are trends. Does this doctor have a ton of leaks? Higher than the average of less than 1%? There is a learning curve to every surgery type. Your doctor has to go through the learning curve just like everyone else. Make sure you are not his learning curve.

I will post an article on Researching Mexican LAP BAND surgeons as well as one on Researching Mexican SLEEVE surgeons. These articles will help you regardless if you are staying in the US and having surgery under insurance, self pay, OR if you are leaving the country for surgery.