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.
Showing posts with label Band. Show all posts
Showing posts with label Band. Show all posts
Thursday, March 25, 2010
Sunday, March 21, 2010
Researching A Mexican Or US Lap Band Surgeon
I wrote this a long time ago on a message board and I am reposting here with some edits and additions. Mostly I am adding a few links such as how to verify a surgeon is Board Certified in Surgery and that sort of information.
This will work for MX or US surgeons. Perhaps someday I will list links for each US state to verify if your US surgeon is Board certified in surgery.
Start with the medical licensing board/bureau in your state. There you can see if the doctor's license is current and in good standing. You can see if the doctor has had any disciplinary action taken against him/her in recent years. In many states, you can see where the doctor went to medical school and how long he/she has been licensed to practice in your state.
Google is also a good tool. Type in your doctor's name and state to see what comes up. Then type in your doctor's name and one of these key search words:
Lawsuits
Malpractice
Complaints
Disciplinary action
Court
Reviews
For Mexican surgeons the link is:
http://www.cmcgac.org.mx/cgi-bin/DirectorioMedicos
To see if that surgeon is a member of the Mexican College of Bariatric Surgeons use this link:
http://www.cmco.org.mx/?q=contact
To verify that a doctor in Mexico is a licensed physician you need his license number and you enter it on this website and it will tell you who the license belongs to:
http://www.cedulaprofesional.sep.gob.mx:7057/cedula/CntConsultaVisitas
I make no secret of the fact that I did a LOT of research on a great deal of Mexican (and American) surgeons before making a decision on my own surgery and I think that because of that I receive a number of private messages asking how to research these surgeons. I researched the dirt and the good information on all the docs I was considering. I had a bit of an advantage as I volunteer in Nogales, Mexico for a trauma surgeon. He helped me to a great deal of my own research and he was able to find out things I might not have known how to find myself. He taught me quite a bit about researching Mexican surgeons.
I decided to start a thread that will give some starting points on researching surgeons. I'm not saying my way is the best way, I am saying this is how I did it. I have learned a few things along the way so I'm going to post this for newbies considering surgery in Mexico.
RESEARCHING MEXICAN LAP BAND SURGEONS 101
Surgery in Mexico is handled a bit different from the US. In the US you will receive a bill from each physician. The surgeon, anesthesiologist, internal medicine doctor, assistant surgeon, radiologist, etc. That is not how it works in Mexico. In Mexico you pay the surgeon for a “package” banding procedure. He pays all the other surgeons.
In the US (for example) the anesthesiologists contract with the hospital and their agreements are with the hospital, not the surgeon. The surgeon does not always get to hand pick the doctor putting you to sleep.
People tend to assume the most important doctor in the operating room is the surgeon. Not so. It’s the anesthesiologist that keeps you ALIVE during surgery. HE is focusing on your breathing, your circulation, your heart, everything. The surgeon is focused on one thing, the surgery. In this case I tend to agree with the way Mexico does things. Do you want the surgeon you trust to pick the anesthesiologist or the hospital’s administrative contract folks, the folks paid to get the best deals? The surgeon is responsible for your surgery overall, he WANTS you to have the best person putting you to sleep. His reputation depends on it. His reputation means his entire career. Without a good reputation they have nothing.
So in Mexico the surgeon hires the anesthesiologist, not the hospital contract office people. This is an example of why it is a “package” cost in Mexico vs. individual bills in the US from all the various medical providers.
Which surgeon?
Avoid choosing a doctor that nobody has heard of before. There is little need to do that. Why take the risk? Surgeons throughout the world have discovered that banding is easy and it has the potential to be extremely profitable. Many physicians are getting in the business, so there are a lot of inexperienced surgeons around. You really want someone that is very experienced. After a bariatric surgeon has done around 250 bands they are typically very confident in the procedure and aftercare. By that time they have seen every strange and bizarre anatomical problem, every odd issue that happens under fluoroscope during fills, etc. So you want to find someone that has done at least 250 bands.
Now, does that mean that someone who has done 3000 bands is better than someone that has done 500 bands? No, not really. Think about it, were you any better at washing dishes the 500th time you did the task vs. the 3000th time? Probably not. Either you get it or you don't. The same concept applies here.
Experience
How long has your doctor been doing bands? No, not how long he has been doing bariatric surgery but how long he’s been doing bands? That is the question you want to ask. Someone can do 4000 lap procedures but that does not mean he has done 4000 bands. A doctor can do 4000 lap procedures and they might all be gastric bypass or removing someones gallbladder. That is not what we are looking for; we are looking for someone very experienced in banding issues. We have different needs and requirements than folks who had bypass and the technique is extremely different for various procedures. There is a learning curve to each procedure and with each procedure the surgeons becomes more skilled and faster at the technique. Do you want to be a part of the learning curve or do you want someone very experienced?
Skill
Skill, I think we should discuss skill a bit. Banding is the easiest surgical bariatric procedure to do. Yes, there is a learning curve but after the learning curve it is without a doubt the easiest procedure to do. That is why so many new surgeons what a piece of the action.
Can your potential doctor do the hard stuff too? Can they do gastric bypass? Gastric sleeves? Duodenal switch (DS)? Can they do revisions such as bypass to banding? Many bypass procedures fail and the patient regains their weight. Banding them is not easy at all. Revisions are difficult. Would you rather have a surgeon that only does the easiest surgical bariatric procedure? Banding? Or do you want a doctor that is capable of doing the difficult and tricky procedures as well as banding? MOST surgeons do not do all the tricky procedures, they just don't have the training, skill, or experience so they stick with the more simple procedure, banding. My personal preference is to have someone that can do it all, even the hard and tricky procedures. Some don't care, they just want a band and they are sure it will be okay. If you want a doctor that can do it all then ask about other procedures. Don't ask IF they can do the tricky and complicated procedures; ask how many they have done.
This brings up another issue. How many bands has a doctor really done? I know of two off the top of my head that have done less than 200 bands but one claims over 1000 bands on his website and another claims over 2000 on his website. Surgeons are people like everyone else and some of them are less than honest. They know that if a patient is researching they are looking for someone experienced. If they told the truth that they have done less than 200 bands they know full well nobody will go to them. So they inflate the numbers so they appear far more experienced than they are. This is not just Mexico; this is with the US and other countries as well.
One doctor combines his stats with that of another. He has done about 100 bands yet his partner has done over 1000 bands so he claims he has done 1200 bands. It simply isn't true.
So read the boards, see the patients that are posting. If someone has done 2000 bands they are going to have patients posting. If they don't, question the numbers.
Patient Coordinators
If you post that you are looking for a band surgeon the patient coordinators are going to come out posting non stop. These are people that are paid to get you to go to their employer. Some of them have been banded and some have not. They will tell you anything you want to hear to talk you into going to their doctor as they usually get anywhere from $300 to $500 for referring you. I am not downing patient coordinators in general. The people I do not like are the people that lie about it. They do not tell you they are making a commission off of your surgery and that is the prime reason they are pushing you to go to one doctor and one only.
If you suspect someone is a patient coordinator do a search of their posts. If the majority of them are pushing a specific doctor vs. giving general advice and thoughts on a topic, it is probably a coordinator. We even caught one coordinator coming up with various screen names so that people would think her doctor has more patients than he does. When people disagree with her she comes up with a new identity, pretends she is another patient, and posts. People think this doctor has more patients and bottom line, he does not.
Believe NOTHING on line. Believe NOTHING that anyone tells you. Verify everything for yourself. I do not care who tells you something, verify the information for yourself. Verify the doctor's credentials, location, years of experience, number of ACTUAL bands, everything. Ask the doctor how many of each brand of band he has placed and then call the band manufacturer and ask if they have actually sold that many bands to that given doctor. One doctor claims to have done 2500 Inamed bands but Inamed disagrees. They have sold him well under 500 bands. One needs to be certified to purchase bands from Inamed. The only place surgeons and hospitals can obtain bands is directly through the company.
Booking Agencies
This is another area of consideration. Do you want to deal with a booking agency? Some do, some don't. It comes down to personal preference. Booking agencies are paid to advertise for several surgeons, they contact the potential patients, they schedule surgery, and they let the doctor know who is coming, for what procedure, and when. They deal with all the issues before and after surgery. Do you want to deal with a booking agency or do you want to deal with the doctor's office directly? Again, there is no right or wrong answer, it is personal preference. Personally, I want to deal directly with my doctor's office. I don't want to deal with a booking agency, some are quite good, and some are not. Just make sure you are dealing with a quality agency.
Where in Mexico?
Now you need to think about if you want surgery near the border or deeper into Mexico. This is something that is purely preference. Some people want to make a mini vacation out of their surgical trip and others do not. Some want to go to Monterrey for a few days ahead of surgery and have a little fun. Others (like me) want to be close to the border. If something happened I wanted to be close to the US. Again, it is a matter of personal preference.
Hospital or clinic?
This is another issue of personal preference. Some people do not mind, others do. Some clinics are absolutely fine and perfectly safe and clean. I preferred a hospital vs. a clinic and the reason is potential complications. Let's be realistic, we are fat. Fat people carry more risk for complications such as heart problems, throwing blood clots, etc. If you have a serious complication in a clinic you will need to be transported to a hospital. Life in Mexico is not like life in the US. In the US if you have a problem in a US surgical center they dial 911 and you are at a hospital within minutes. That is not the case in Mexico. Yes, they do have emergency services but it is not similar to the US. They will get to you when they can. That is not immediate. For that reason I personally preferred a hospital. The risk for banding complications is quite low but it does happen. If it did happen I wanted to already be in a hospital.
Price
What about price? Many make the mistake of shopping by price and quite frankly there are times in life that you really do get what you pay for. Cheaper is not always better. Keep in mind that with Inamed and Johnson & Johnson bands the cost to the doctor is $2000 per band. That's what the surgeons in Mexico pay for the band. If the doctor is really cheap he is cutting corners somewhere or... he is so bad that the only patients he gets are people shopping for price vs. surgeon skill. There is also little need to go to the most expensive doctor. Expensive does not mean skilled, it means expensive.
Patient Testimonials
Patient testimonials are critical to read. Go to www.obesityhelp.com and research your doctor. OH makes it very difficult to research Mexican surgeons, they make it quite simple to research US surgeons. For Mexican surgeons you need to research by specific name vs. US surgeons you can research by geographical location. There should be plenty of patient testimonials. If there are not, that might be a problem. See what the trends are. There will always be patients that no matter what is done they will never be happy so if there are 0.001% of testimonials that are not great, look at the overall picture. If people are happy they will say so if they are taking the time to write a testimonial. Just make sure to read the opinions of a LOT of patients and not just a few.
Talking to people on line is a great way to get an idea of surgeons. But talking to a few people and feeling that they did well during surgery and that's your research, that is just dead wrong. You need to read at least 100 patient testimonials or talk to at least 100 people about their surgery.
Do a www.obesityhelp.com search on the name of the doctor you are looking at. Read it all. Do not ignore the bad, read it. If you have questions send the author a private message. There are two surgeons I can think of that have the absolute worst reputations in Mexico yet people are unwilling to take the time to do a search on their doctor and they are surprised after they announce they are going to Dr. "X" and people are shocked. People will try to warn them and tell them they are not going to a skilled surgeon but they refuse to listen and it is typically price that formed their decision or they really "like" a poster and that poster went to Dr. "X". Some people are simply sick of researching so even when they realize they did not choose the best physician for them, they go anyway. Others are desperate for a band and they no longer care about skill level. Be very careful and do the research.
I know of one person that had two friends that went to a specific doctor and that was her research. That's it, that is all she did. She went to the same doctor and ended up with an infection so severe she will lose her band. Actually, she probably already has lost it at this point. She also went to one of the two worst surgeons in Mexico. It happens all the time and it is not just Mexican surgeons that cause infections, it happens in the US. You are not going to all the expense and trouble to be banded just to lose your band (and potentially your life) to a crappy surgeon. Do your research.
People make huge claims here about their surgeons and they simply are not true. "My surgeon is a LEADING" surgeon in banding." Well, what does that mean exactly? What is a leading surgeon? "My surgeon is a TOP banding surgeon." Says who? Who makes these claims? I'll tell you who makes them; the surgeons make the claims about themselves. I can say I am a "LEADING" nurse, does that mean anything? Does it make it true?
Pre-Op Testing
This is critical to have a safe surgery. You should get AT LEAST a complete blood count, chemistry panel, urine test, EKG, and chest x-ray. Do not settle for anything less. If the doctor does less testing than this he is pinching pennies in all the wrong places. This is your health, you are paying for these tests, make sure you get them. I know of one doctor that claims he does an EKG during surgery. That is NOT an EKG! That is a heart monitor and it does not have the same information as a full EKG. Besides, one of the issues they are looking for during surgery on the heart monitor is if there are any heart changes due to the anesthesia. If you didn't have an EKG before surgery how will they know if there are changes due to anesthesia? If you don not get these tests that you are paying for, the money is just going in your doctor's pocket instead of your health care. You are the consumer here, insist on the appropriate testing. Do you want your money for banding going towards your health care or your doctor’s new swimming pool? Bariatric surgeons are not typically hurting for money. They are being paid to do ALL the tests, get them done.
Post-Op Testing
This should be a barium swallow that is done after surgery. One doctor's office claims they cannot do a barium swallow after surgery because the barium is too thick. This is simply untrue. Barium comes in a powder form and it can be made as thin or as thick as needed. It can be watery or it can be very thick. The only reason for not doing a post op barium swallow is to save the doctor money. Again, this is a procedure you pay for, make sure you get it.
You want a barium swallow after surgery for various reasons. Example: What if you get home and have some sort of complication? You are going to have to have it done anyway and at home you'll be paying full price and your insurance is not likely to cover it. Considering you already paid for it in your surgery package you should have had it. You should be given the films to take home with you after this test when done in Mexico along with all your labs, EKG, etc.
You also want this test to make sure you are safe to travel back to the US. A barium swallow makes sure that band placement is correct, fluid is traveling through your stoma, and there are no unexpected medical problems. It also does a great deal for you as a patient. When you can actually see the band and see the band working with your own two eyes, this makes a world of difference. It puts things in perspective for you as a patient.
What if you go for your first fill and your fill doc does not use fluoro? It is nice for him to see the films so that he can see where your port is and believe me, that makes it easier for you while he is looking for your port.
So there are many reasons to get the barium swallow after surgery. If your potential doc does not offer this important test, find a new doctor. You are paying for it, so get it.
Nude/Semi Nude Photos
Some surgeons in the US and Mexico require pre op photos, some do not. Some require photos of you nude, some give paper undergarments to wear, some take pictures of you in your bra/underwear, some take photos fully clothed. They don’t typically tell you this until you arrive for surgery. You should probably ask if this is a requirement. If you choose to decline ask if they will decline to do your surgery. Quite frankly, that would have been a deal-breaker for me. I declined to keep any photos of myself at my highest weight and those were photos of me fully clothed that I owned, I would have never agreed to nude/semi nude photos for a doctor and his research. But not everyone has a problem with this.
The reasons for photos vary. Some are using them for research. Some want to be able to prove the surgery was necessary if it ever becomes an issue. But you have the right to not have nude/semi nude photos of yourself or photos of you at your largest floating around this world where they are out of your personal control. It is your body, do what you believe is right. I have yet to hear of any such photos being compromised so that isn’t the issue as much as the issue of your right to privacy. Do what is right for you, not your doctor when it comes to these kinds of photos.
Supervision
Regardless if you have surgery in a hospital or clinic you should have a certain amount of medical supervision. If you are in a hospital you will have that. If you are in a clinic you will have it. What about after you are discharged? It is quite common for patients to be sent to a hotel for an extra day of recovery while in Mexico. Some physicians do this, others keep you in the hospital the entire time you are in Mexico after surgery. What kind of supervision is there for you in a hotel? Is someone coming to visit you and check on you? Are they at least calling you? All surgeons will tell you they are available but this is where you need to talk to other patients that went to that doctor. Ask them specifically, how much interaction did they have with the doctor or his staff while in the hotel.
Pre-Op Diets
It is common for surgeons to put patients on a pre-op diet before surgery. Many still say it is to shrink the liver, but that isn't quite true. The reality is that if someone is on a low-carb, low-fat, adequate-protein diet of some sort they will lose weight and their liver will have less of a "slimy" feeling to it. It won't slip around as much during surgery. Every 10lbs you lose before surgery it makes it easier for your surgeon to do the procedure. The easier the procedure is for your surgeon, the safer it will be for you.
During surgery there are several incisions made and one of them is basically to hold the liver out of the way so the doctor can get to your stomach and secure the band around it. If it is slippery and difficult to manage, it makes it more dangerous for you, so the pre op diet is indeed quite important. Studies show that the liver does not actually start to shrink in size until you have been on such a diet for about six weeks or longer. Again, it is still quite important to follow the diet for your safety. Some surgeons do not require the diet because it does not actually "shrink" the liver. Others do. It comes down to surgeon preference. Some surgeons only require it for a specific BMI or higher. You need to ask about the pre-op diet and you need to know specifics.
Post-Op Diets
Most people believe the post-op diet means that when the stomach swelling is gone they are good to go and they can eat anything they wish. That is NOT the purpose for the post-op diet! Just because you CAN eat solid foods does not mean you SHOULD eat them. The diet has little to do with swelling and a great deal to do with other issues. But that is a post for another day. Find out what your doctor's post-op diet is, make sure you understand it well, and if you do not then ask questions.
Surgeon’s Staff
How easy is it for you to reach your potential doctor's staff? Keep in mind, when you are a potential newbie they will be on their best behavior. They will return phone calls and emails much faster than they will after you are scheduled and have surgery. So if you have a difficult time reaching the staff before surgery, what will happen if you have a problem after surgery and need to reach them? What about the middle of the night? Who answers their phones then? Remember that if you have problems in the middle of the night after surgery you will need to have someone you can contact in a pinch.
Statistics
You should ask your potential doctor's office about his stats for infection, slips, and erosion. Infection stats should be less than 1%. Keep in mind, not all infection is the fault of the doctor. There was a person I recently read that posted she went swimming in a public pool 4 days after surgery. Her post op instructions specifically said not to do that. Children PEE in public swimming pools; do you want your newly healing incisions soaking in pool water with urine? If you do that and you get an infection is that the fault of your doctor? Even though it isn't his fault it will still go against his infection stats, so keep that in mind. Even so, infection should be less than 1%. MUCH less.
I am of the opinion that most slips (not all) but most are the fault of the patient. Not eating the right foods, not chewing well enough and PBing, etc. Global slip stats according to Inamed are around 3% so your doc's slip stats should be less than 3%.
The latest thinking is that erosion is from a band that is too tight. That can be a band that was too small for the patient at the time of surgery or the patient got a fill that was too tight and they did nothing about it. Global erosion stats according to Inamed are 1.3%, so your doc should be well under 1.3% for erosion stats.
There is one doctor who has a 4% erosion stat. When it came out on the boards that this is a concerning number they changed the way they word things. Instead of saying >1% infection, >2% slips, and >4% erosion he now combines ALL stats and says that his stats are less than 3%. He's just averaging them out to avoid the truth of the 4% erosion figure. An overall complication of about 3% doesn't sound NEARLY as bad as 4% erosion. But do people pay attention to these things? NO! They don't. So be very careful to ask for each individual statistic.
There is another trick to watch for. Ask your potential surgeon how many bands he has placed. Then ask if his stats for infection, erosion, and slips are the figures for 100% of his bands placed or if they are for a smaller number. If a doctor has a given statistic of 4% for slips, erosion, or infection but he will only provide you with the statistics from a given group or given study, those are not true figures.
For example, if a doctor claims to have done 1000 bands but claims an erosion statistic of >1% for the last 300 of those bands, why isn’t he telling you his true erosion statistics for all 1000 bands? They get tricky and you have to see what they are doing. They are being honest in the sense that they are telling you their statistics but only the good statistics. They are hiding the bad (and more accurate) numbers from you. This is another reason you need to research and this applies to US surgeons as well as Mexican or any other country.
If they are a good doctor with a proven track record there is little reason to be deceptive, play games, and hide facts as their reputation and background should speak for itself. But do stop and think about it, if they are attempting to hide figures from you - they are doing this knowing full well their deception. Is this the surgeon you want to trust your health care and your life?
If you contact them again and the give you three pages of nonsense that still does not answer your specific questions, they are attempting to talk around your questions. No good physician will attempt this. They will just bloody well give you the numbers you have requested. If it is like pulling teeth to get the actual numbers, walk away. Find someone a little more honest.
Which band will you receive?
There are currently two brands of bands FDA approved in the US. Inamed and J&J. J&J was only recently approved for use in the United States, and many US surgeons may not have experience with them. Remember this when you are arranging aftercare. It will be hard to obtain a fill for bands other than these two brands, as a US doctor can have problems with the licensing board if he works with a non-FDA approved device. Take this into consideration. If you get an Inamed brand band you should be given the empty box, an instruction book, and an ID card showing the size and type of band you have. If you get a J&J band you should receive the empty box, two booklets, and an ID card. You may need these items to prove to a US doctor that you have an FDA approved device so they can do your fills. Not all surgeons require you to show them the box and information but some do.
Transportation
How will you get from the airport to the hospital or clinic? What about the hotel? Does the doctor provide this? Most do. You should have no additional transportation expenses and this should be taken care of for you by the MD office. You should be able to take $50 with you for incidentals, tips (airport, etc.) and dinner before surgery. Everything else should be included in your surgery package.
Finding a Fill Doctor
Make sure you an find a doctor within driving distance of you before heading to Mexico for surgery. Some live close enough to the border to drive there, for others it is an inexpensive flight for fills. Regardless, you need to work out a fill person BEFORE having surgery in Mexico.
This will work for MX or US surgeons. Perhaps someday I will list links for each US state to verify if your US surgeon is Board certified in surgery.
Start with the medical licensing board/bureau in your state. There you can see if the doctor's license is current and in good standing. You can see if the doctor has had any disciplinary action taken against him/her in recent years. In many states, you can see where the doctor went to medical school and how long he/she has been licensed to practice in your state.
Google is also a good tool. Type in your doctor's name and state to see what comes up. Then type in your doctor's name and one of these key search words:
Lawsuits
Malpractice
Complaints
Disciplinary action
Court
Reviews
For Mexican surgeons the link is:
http://www.cmcgac.org.mx/cgi-bin/DirectorioMedicos
To see if that surgeon is a member of the Mexican College of Bariatric Surgeons use this link:
http://www.cmco.org.mx/?q=contact
To verify that a doctor in Mexico is a licensed physician you need his license number and you enter it on this website and it will tell you who the license belongs to:
http://www.cedulaprofesional.sep.gob.mx:7057/cedula/CntConsultaVisitas
I make no secret of the fact that I did a LOT of research on a great deal of Mexican (and American) surgeons before making a decision on my own surgery and I think that because of that I receive a number of private messages asking how to research these surgeons. I researched the dirt and the good information on all the docs I was considering. I had a bit of an advantage as I volunteer in Nogales, Mexico for a trauma surgeon. He helped me to a great deal of my own research and he was able to find out things I might not have known how to find myself. He taught me quite a bit about researching Mexican surgeons.
I decided to start a thread that will give some starting points on researching surgeons. I'm not saying my way is the best way, I am saying this is how I did it. I have learned a few things along the way so I'm going to post this for newbies considering surgery in Mexico.
RESEARCHING MEXICAN LAP BAND SURGEONS 101
Surgery in Mexico is handled a bit different from the US. In the US you will receive a bill from each physician. The surgeon, anesthesiologist, internal medicine doctor, assistant surgeon, radiologist, etc. That is not how it works in Mexico. In Mexico you pay the surgeon for a “package” banding procedure. He pays all the other surgeons.
In the US (for example) the anesthesiologists contract with the hospital and their agreements are with the hospital, not the surgeon. The surgeon does not always get to hand pick the doctor putting you to sleep.
People tend to assume the most important doctor in the operating room is the surgeon. Not so. It’s the anesthesiologist that keeps you ALIVE during surgery. HE is focusing on your breathing, your circulation, your heart, everything. The surgeon is focused on one thing, the surgery. In this case I tend to agree with the way Mexico does things. Do you want the surgeon you trust to pick the anesthesiologist or the hospital’s administrative contract folks, the folks paid to get the best deals? The surgeon is responsible for your surgery overall, he WANTS you to have the best person putting you to sleep. His reputation depends on it. His reputation means his entire career. Without a good reputation they have nothing.
So in Mexico the surgeon hires the anesthesiologist, not the hospital contract office people. This is an example of why it is a “package” cost in Mexico vs. individual bills in the US from all the various medical providers.
Which surgeon?
Avoid choosing a doctor that nobody has heard of before. There is little need to do that. Why take the risk? Surgeons throughout the world have discovered that banding is easy and it has the potential to be extremely profitable. Many physicians are getting in the business, so there are a lot of inexperienced surgeons around. You really want someone that is very experienced. After a bariatric surgeon has done around 250 bands they are typically very confident in the procedure and aftercare. By that time they have seen every strange and bizarre anatomical problem, every odd issue that happens under fluoroscope during fills, etc. So you want to find someone that has done at least 250 bands.
Now, does that mean that someone who has done 3000 bands is better than someone that has done 500 bands? No, not really. Think about it, were you any better at washing dishes the 500th time you did the task vs. the 3000th time? Probably not. Either you get it or you don't. The same concept applies here.
Experience
How long has your doctor been doing bands? No, not how long he has been doing bariatric surgery but how long he’s been doing bands? That is the question you want to ask. Someone can do 4000 lap procedures but that does not mean he has done 4000 bands. A doctor can do 4000 lap procedures and they might all be gastric bypass or removing someones gallbladder. That is not what we are looking for; we are looking for someone very experienced in banding issues. We have different needs and requirements than folks who had bypass and the technique is extremely different for various procedures. There is a learning curve to each procedure and with each procedure the surgeons becomes more skilled and faster at the technique. Do you want to be a part of the learning curve or do you want someone very experienced?
Skill
Skill, I think we should discuss skill a bit. Banding is the easiest surgical bariatric procedure to do. Yes, there is a learning curve but after the learning curve it is without a doubt the easiest procedure to do. That is why so many new surgeons what a piece of the action.
Can your potential doctor do the hard stuff too? Can they do gastric bypass? Gastric sleeves? Duodenal switch (DS)? Can they do revisions such as bypass to banding? Many bypass procedures fail and the patient regains their weight. Banding them is not easy at all. Revisions are difficult. Would you rather have a surgeon that only does the easiest surgical bariatric procedure? Banding? Or do you want a doctor that is capable of doing the difficult and tricky procedures as well as banding? MOST surgeons do not do all the tricky procedures, they just don't have the training, skill, or experience so they stick with the more simple procedure, banding. My personal preference is to have someone that can do it all, even the hard and tricky procedures. Some don't care, they just want a band and they are sure it will be okay. If you want a doctor that can do it all then ask about other procedures. Don't ask IF they can do the tricky and complicated procedures; ask how many they have done.
This brings up another issue. How many bands has a doctor really done? I know of two off the top of my head that have done less than 200 bands but one claims over 1000 bands on his website and another claims over 2000 on his website. Surgeons are people like everyone else and some of them are less than honest. They know that if a patient is researching they are looking for someone experienced. If they told the truth that they have done less than 200 bands they know full well nobody will go to them. So they inflate the numbers so they appear far more experienced than they are. This is not just Mexico; this is with the US and other countries as well.
One doctor combines his stats with that of another. He has done about 100 bands yet his partner has done over 1000 bands so he claims he has done 1200 bands. It simply isn't true.
So read the boards, see the patients that are posting. If someone has done 2000 bands they are going to have patients posting. If they don't, question the numbers.
Patient Coordinators
If you post that you are looking for a band surgeon the patient coordinators are going to come out posting non stop. These are people that are paid to get you to go to their employer. Some of them have been banded and some have not. They will tell you anything you want to hear to talk you into going to their doctor as they usually get anywhere from $300 to $500 for referring you. I am not downing patient coordinators in general. The people I do not like are the people that lie about it. They do not tell you they are making a commission off of your surgery and that is the prime reason they are pushing you to go to one doctor and one only.
If you suspect someone is a patient coordinator do a search of their posts. If the majority of them are pushing a specific doctor vs. giving general advice and thoughts on a topic, it is probably a coordinator. We even caught one coordinator coming up with various screen names so that people would think her doctor has more patients than he does. When people disagree with her she comes up with a new identity, pretends she is another patient, and posts. People think this doctor has more patients and bottom line, he does not.
Believe NOTHING on line. Believe NOTHING that anyone tells you. Verify everything for yourself. I do not care who tells you something, verify the information for yourself. Verify the doctor's credentials, location, years of experience, number of ACTUAL bands, everything. Ask the doctor how many of each brand of band he has placed and then call the band manufacturer and ask if they have actually sold that many bands to that given doctor. One doctor claims to have done 2500 Inamed bands but Inamed disagrees. They have sold him well under 500 bands. One needs to be certified to purchase bands from Inamed. The only place surgeons and hospitals can obtain bands is directly through the company.
Booking Agencies
This is another area of consideration. Do you want to deal with a booking agency? Some do, some don't. It comes down to personal preference. Booking agencies are paid to advertise for several surgeons, they contact the potential patients, they schedule surgery, and they let the doctor know who is coming, for what procedure, and when. They deal with all the issues before and after surgery. Do you want to deal with a booking agency or do you want to deal with the doctor's office directly? Again, there is no right or wrong answer, it is personal preference. Personally, I want to deal directly with my doctor's office. I don't want to deal with a booking agency, some are quite good, and some are not. Just make sure you are dealing with a quality agency.
Where in Mexico?
Now you need to think about if you want surgery near the border or deeper into Mexico. This is something that is purely preference. Some people want to make a mini vacation out of their surgical trip and others do not. Some want to go to Monterrey for a few days ahead of surgery and have a little fun. Others (like me) want to be close to the border. If something happened I wanted to be close to the US. Again, it is a matter of personal preference.
Hospital or clinic?
This is another issue of personal preference. Some people do not mind, others do. Some clinics are absolutely fine and perfectly safe and clean. I preferred a hospital vs. a clinic and the reason is potential complications. Let's be realistic, we are fat. Fat people carry more risk for complications such as heart problems, throwing blood clots, etc. If you have a serious complication in a clinic you will need to be transported to a hospital. Life in Mexico is not like life in the US. In the US if you have a problem in a US surgical center they dial 911 and you are at a hospital within minutes. That is not the case in Mexico. Yes, they do have emergency services but it is not similar to the US. They will get to you when they can. That is not immediate. For that reason I personally preferred a hospital. The risk for banding complications is quite low but it does happen. If it did happen I wanted to already be in a hospital.
Price
What about price? Many make the mistake of shopping by price and quite frankly there are times in life that you really do get what you pay for. Cheaper is not always better. Keep in mind that with Inamed and Johnson & Johnson bands the cost to the doctor is $2000 per band. That's what the surgeons in Mexico pay for the band. If the doctor is really cheap he is cutting corners somewhere or... he is so bad that the only patients he gets are people shopping for price vs. surgeon skill. There is also little need to go to the most expensive doctor. Expensive does not mean skilled, it means expensive.
Patient Testimonials
Patient testimonials are critical to read. Go to www.obesityhelp.com and research your doctor. OH makes it very difficult to research Mexican surgeons, they make it quite simple to research US surgeons. For Mexican surgeons you need to research by specific name vs. US surgeons you can research by geographical location. There should be plenty of patient testimonials. If there are not, that might be a problem. See what the trends are. There will always be patients that no matter what is done they will never be happy so if there are 0.001% of testimonials that are not great, look at the overall picture. If people are happy they will say so if they are taking the time to write a testimonial. Just make sure to read the opinions of a LOT of patients and not just a few.
Talking to people on line is a great way to get an idea of surgeons. But talking to a few people and feeling that they did well during surgery and that's your research, that is just dead wrong. You need to read at least 100 patient testimonials or talk to at least 100 people about their surgery.
Do a www.obesityhelp.com search on the name of the doctor you are looking at. Read it all. Do not ignore the bad, read it. If you have questions send the author a private message. There are two surgeons I can think of that have the absolute worst reputations in Mexico yet people are unwilling to take the time to do a search on their doctor and they are surprised after they announce they are going to Dr. "X" and people are shocked. People will try to warn them and tell them they are not going to a skilled surgeon but they refuse to listen and it is typically price that formed their decision or they really "like" a poster and that poster went to Dr. "X". Some people are simply sick of researching so even when they realize they did not choose the best physician for them, they go anyway. Others are desperate for a band and they no longer care about skill level. Be very careful and do the research.
I know of one person that had two friends that went to a specific doctor and that was her research. That's it, that is all she did. She went to the same doctor and ended up with an infection so severe she will lose her band. Actually, she probably already has lost it at this point. She also went to one of the two worst surgeons in Mexico. It happens all the time and it is not just Mexican surgeons that cause infections, it happens in the US. You are not going to all the expense and trouble to be banded just to lose your band (and potentially your life) to a crappy surgeon. Do your research.
People make huge claims here about their surgeons and they simply are not true. "My surgeon is a LEADING" surgeon in banding." Well, what does that mean exactly? What is a leading surgeon? "My surgeon is a TOP banding surgeon." Says who? Who makes these claims? I'll tell you who makes them; the surgeons make the claims about themselves. I can say I am a "LEADING" nurse, does that mean anything? Does it make it true?
Pre-Op Testing
This is critical to have a safe surgery. You should get AT LEAST a complete blood count, chemistry panel, urine test, EKG, and chest x-ray. Do not settle for anything less. If the doctor does less testing than this he is pinching pennies in all the wrong places. This is your health, you are paying for these tests, make sure you get them. I know of one doctor that claims he does an EKG during surgery. That is NOT an EKG! That is a heart monitor and it does not have the same information as a full EKG. Besides, one of the issues they are looking for during surgery on the heart monitor is if there are any heart changes due to the anesthesia. If you didn't have an EKG before surgery how will they know if there are changes due to anesthesia? If you don not get these tests that you are paying for, the money is just going in your doctor's pocket instead of your health care. You are the consumer here, insist on the appropriate testing. Do you want your money for banding going towards your health care or your doctor’s new swimming pool? Bariatric surgeons are not typically hurting for money. They are being paid to do ALL the tests, get them done.
Post-Op Testing
This should be a barium swallow that is done after surgery. One doctor's office claims they cannot do a barium swallow after surgery because the barium is too thick. This is simply untrue. Barium comes in a powder form and it can be made as thin or as thick as needed. It can be watery or it can be very thick. The only reason for not doing a post op barium swallow is to save the doctor money. Again, this is a procedure you pay for, make sure you get it.
You want a barium swallow after surgery for various reasons. Example: What if you get home and have some sort of complication? You are going to have to have it done anyway and at home you'll be paying full price and your insurance is not likely to cover it. Considering you already paid for it in your surgery package you should have had it. You should be given the films to take home with you after this test when done in Mexico along with all your labs, EKG, etc.
You also want this test to make sure you are safe to travel back to the US. A barium swallow makes sure that band placement is correct, fluid is traveling through your stoma, and there are no unexpected medical problems. It also does a great deal for you as a patient. When you can actually see the band and see the band working with your own two eyes, this makes a world of difference. It puts things in perspective for you as a patient.
What if you go for your first fill and your fill doc does not use fluoro? It is nice for him to see the films so that he can see where your port is and believe me, that makes it easier for you while he is looking for your port.
So there are many reasons to get the barium swallow after surgery. If your potential doc does not offer this important test, find a new doctor. You are paying for it, so get it.
Nude/Semi Nude Photos
Some surgeons in the US and Mexico require pre op photos, some do not. Some require photos of you nude, some give paper undergarments to wear, some take pictures of you in your bra/underwear, some take photos fully clothed. They don’t typically tell you this until you arrive for surgery. You should probably ask if this is a requirement. If you choose to decline ask if they will decline to do your surgery. Quite frankly, that would have been a deal-breaker for me. I declined to keep any photos of myself at my highest weight and those were photos of me fully clothed that I owned, I would have never agreed to nude/semi nude photos for a doctor and his research. But not everyone has a problem with this.
The reasons for photos vary. Some are using them for research. Some want to be able to prove the surgery was necessary if it ever becomes an issue. But you have the right to not have nude/semi nude photos of yourself or photos of you at your largest floating around this world where they are out of your personal control. It is your body, do what you believe is right. I have yet to hear of any such photos being compromised so that isn’t the issue as much as the issue of your right to privacy. Do what is right for you, not your doctor when it comes to these kinds of photos.
Supervision
Regardless if you have surgery in a hospital or clinic you should have a certain amount of medical supervision. If you are in a hospital you will have that. If you are in a clinic you will have it. What about after you are discharged? It is quite common for patients to be sent to a hotel for an extra day of recovery while in Mexico. Some physicians do this, others keep you in the hospital the entire time you are in Mexico after surgery. What kind of supervision is there for you in a hotel? Is someone coming to visit you and check on you? Are they at least calling you? All surgeons will tell you they are available but this is where you need to talk to other patients that went to that doctor. Ask them specifically, how much interaction did they have with the doctor or his staff while in the hotel.
Pre-Op Diets
It is common for surgeons to put patients on a pre-op diet before surgery. Many still say it is to shrink the liver, but that isn't quite true. The reality is that if someone is on a low-carb, low-fat, adequate-protein diet of some sort they will lose weight and their liver will have less of a "slimy" feeling to it. It won't slip around as much during surgery. Every 10lbs you lose before surgery it makes it easier for your surgeon to do the procedure. The easier the procedure is for your surgeon, the safer it will be for you.
During surgery there are several incisions made and one of them is basically to hold the liver out of the way so the doctor can get to your stomach and secure the band around it. If it is slippery and difficult to manage, it makes it more dangerous for you, so the pre op diet is indeed quite important. Studies show that the liver does not actually start to shrink in size until you have been on such a diet for about six weeks or longer. Again, it is still quite important to follow the diet for your safety. Some surgeons do not require the diet because it does not actually "shrink" the liver. Others do. It comes down to surgeon preference. Some surgeons only require it for a specific BMI or higher. You need to ask about the pre-op diet and you need to know specifics.
Post-Op Diets
Most people believe the post-op diet means that when the stomach swelling is gone they are good to go and they can eat anything they wish. That is NOT the purpose for the post-op diet! Just because you CAN eat solid foods does not mean you SHOULD eat them. The diet has little to do with swelling and a great deal to do with other issues. But that is a post for another day. Find out what your doctor's post-op diet is, make sure you understand it well, and if you do not then ask questions.
Surgeon’s Staff
How easy is it for you to reach your potential doctor's staff? Keep in mind, when you are a potential newbie they will be on their best behavior. They will return phone calls and emails much faster than they will after you are scheduled and have surgery. So if you have a difficult time reaching the staff before surgery, what will happen if you have a problem after surgery and need to reach them? What about the middle of the night? Who answers their phones then? Remember that if you have problems in the middle of the night after surgery you will need to have someone you can contact in a pinch.
Statistics
You should ask your potential doctor's office about his stats for infection, slips, and erosion. Infection stats should be less than 1%. Keep in mind, not all infection is the fault of the doctor. There was a person I recently read that posted she went swimming in a public pool 4 days after surgery. Her post op instructions specifically said not to do that. Children PEE in public swimming pools; do you want your newly healing incisions soaking in pool water with urine? If you do that and you get an infection is that the fault of your doctor? Even though it isn't his fault it will still go against his infection stats, so keep that in mind. Even so, infection should be less than 1%. MUCH less.
I am of the opinion that most slips (not all) but most are the fault of the patient. Not eating the right foods, not chewing well enough and PBing, etc. Global slip stats according to Inamed are around 3% so your doc's slip stats should be less than 3%.
The latest thinking is that erosion is from a band that is too tight. That can be a band that was too small for the patient at the time of surgery or the patient got a fill that was too tight and they did nothing about it. Global erosion stats according to Inamed are 1.3%, so your doc should be well under 1.3% for erosion stats.
There is one doctor who has a 4% erosion stat. When it came out on the boards that this is a concerning number they changed the way they word things. Instead of saying >1% infection, >2% slips, and >4% erosion he now combines ALL stats and says that his stats are less than 3%. He's just averaging them out to avoid the truth of the 4% erosion figure. An overall complication of about 3% doesn't sound NEARLY as bad as 4% erosion. But do people pay attention to these things? NO! They don't. So be very careful to ask for each individual statistic.
There is another trick to watch for. Ask your potential surgeon how many bands he has placed. Then ask if his stats for infection, erosion, and slips are the figures for 100% of his bands placed or if they are for a smaller number. If a doctor has a given statistic of 4% for slips, erosion, or infection but he will only provide you with the statistics from a given group or given study, those are not true figures.
For example, if a doctor claims to have done 1000 bands but claims an erosion statistic of >1% for the last 300 of those bands, why isn’t he telling you his true erosion statistics for all 1000 bands? They get tricky and you have to see what they are doing. They are being honest in the sense that they are telling you their statistics but only the good statistics. They are hiding the bad (and more accurate) numbers from you. This is another reason you need to research and this applies to US surgeons as well as Mexican or any other country.
If they are a good doctor with a proven track record there is little reason to be deceptive, play games, and hide facts as their reputation and background should speak for itself. But do stop and think about it, if they are attempting to hide figures from you - they are doing this knowing full well their deception. Is this the surgeon you want to trust your health care and your life?
If you contact them again and the give you three pages of nonsense that still does not answer your specific questions, they are attempting to talk around your questions. No good physician will attempt this. They will just bloody well give you the numbers you have requested. If it is like pulling teeth to get the actual numbers, walk away. Find someone a little more honest.
Which band will you receive?
There are currently two brands of bands FDA approved in the US. Inamed and J&J. J&J was only recently approved for use in the United States, and many US surgeons may not have experience with them. Remember this when you are arranging aftercare. It will be hard to obtain a fill for bands other than these two brands, as a US doctor can have problems with the licensing board if he works with a non-FDA approved device. Take this into consideration. If you get an Inamed brand band you should be given the empty box, an instruction book, and an ID card showing the size and type of band you have. If you get a J&J band you should receive the empty box, two booklets, and an ID card. You may need these items to prove to a US doctor that you have an FDA approved device so they can do your fills. Not all surgeons require you to show them the box and information but some do.
Transportation
How will you get from the airport to the hospital or clinic? What about the hotel? Does the doctor provide this? Most do. You should have no additional transportation expenses and this should be taken care of for you by the MD office. You should be able to take $50 with you for incidentals, tips (airport, etc.) and dinner before surgery. Everything else should be included in your surgery package.
Finding a Fill Doctor
Make sure you an find a doctor within driving distance of you before heading to Mexico for surgery. Some live close enough to the border to drive there, for others it is an inexpensive flight for fills. Regardless, you need to work out a fill person BEFORE having surgery in Mexico.
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