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 Sleeve. Show all posts
Showing posts with label Sleeve. Show all posts
Thursday, March 25, 2010
Monday, March 22, 2010
Researching A Mexican Or US Sleeve OR Gastric Bypass Surgeon
RESEARCHING A MEXICAN OR US SLEEVE SURGEON 101
Getting a Vertical Sleeve Gastrectomy/Sleeve Procedure
***It has come to my attention that there is a man in Tijuana, Mexico that is posing as a physician, not a surgeon and no - he is not doing surgery he merely owns the clinic. This man is posing as a physician and he is not a physician. He has never been to medical school, he has no formal medical education. ANYONE that claims to be a physician or surgeon you should verify this through the Mexican Government. You need to obtain the license number of the physician and enter it to the following website. The true owner of the license will show up. There is absolutely no reason any licensed physician would deny you their license number, none!***
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
Surgery in Mexico is handled a bit differently than it is in the United States. 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" Gastric Sleeve procedure. He pays all the other doctors.
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. This is 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. 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.
Choosing a surgeon
Avoid choosing a doctor that nobody has heard of before. There is little need to do that. Why take the risk? Doctors throughout the world have discovered that bariatric surgery has the potential to be extremely profitable. Many physicians are getting in the business, so there are a lot of inexperienced surgeons around. You ONLY want someone who is very experienced. After a bariatric surgeon has done around 250 sleeves 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, etc. So you want to find someone that has done at least 250 sleeve surgeries.
Now, does that mean that someone who has done 500 sleeves is better than someone that has done 250 sleeves? Not exactly. One way to think about it: were you any better at washing dishes the 250th time you did the task vs. the 500th time? That's probably not so. Either you get it or you don't. The same concept applies here.
FACS (Fellow of the American College of Surgeons)
If you do not know how to verify licensing, credentials, education, history, etc., your best bet is to choose a doctor that is a Fellow of the American College of Surgeons. It takes about 8 months for the American College of Surgeons to do their background investigation of a doctor. If they have "FACS" behind their name then they must exceed the requirements for a US physician. Don't bank on what you are told by the coordinators, if they say the doctor is FACS then verify it for yourself. Go to Welcome to the American College of Surgeons and obtain the (800) number from their website and call. Ask them if it is true the doctor you are researching is indeed a Fellow. You can search on their website but their website is often times hard to navigate. It's easier to call them and obtain the information over the phone.
Please note: There are doctors that claim to be FACS and they are not. They are banking that you will not verify this information. Do not take the office staff or MD's word for it that they are FaCS, go to their website and verify for yourself. That website is:
www.FACS.org
If you are unsure call the (800) and ask the FACS staff, they will assist you.
Experience
How long has your doctor been doing sleeves? No, not how long he has been doing bariatric surgery but how long he's been doing sleeves? That is the question you want to ask. Someone can do 4000 lap procedures but that does not mean he has done 4000 sleeves. A doctor can do 4000 lap procedures and they might all be Lap Bands or removing someone's gallbladder. That is not what we are looking for; we are looking for someone very experienced in sleeve issues. We have different needs and requirements than folks who had a Lap Band and the technique is extremely different for various procedures. There is a learning curve to each procedure, and with each procedure the doctors 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?
Many make the mistake of thinking that they really "like" their doctor and they bank on personality instead of skill. This is a major mistake.
Find someone who has done *at least* 250 sleeves AND 250 Gastric Bypass procedures. The Bypass staple line is quite difficult to do and not everyone can do it. It can't be over sewn or secured so it takes great skill to do this type of staple line. If someone can do a bypass staple line without problems then they should be fine with a sleeve staple line. If they can't do a difficult bypass staple line then do you want them doing any staple line on you?
Skill
We should discuss skill. Banding is the easiest surgical bariatric procedure to do. Yes, there is a learning curve; however, after the learning curve it is without a doubt the easiest procedure to do. That is why so many new doctors what a piece of the action. After they do a few bands they decide to start getting into the trickier procedures such as bypass and sleeves.
Can your potential doctor do the hard stuff too? Can they do gastric bypass? Duodenal switch (DS)? Can they do revisions such as bypass to banding? Many bypass procedures fail and the patient regains their weight. Band after bypass 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 doctors do not do all the tricky procedures, they just don't have the training, skill, or experience so they stick with less complicated procedures. My personal preference is to have someone that can do it all, even the difficult and tricky procedures. Some don't care, they just want a sleeve 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 sleeves has a doctor really done? I know of one in Mexico that has done less than 200-300 sleeves, yet he claims astronomical numbers on his website. Doctors 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 100 sleeves 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 300 bands and 300 sleeves yet his partner has done over 5000 bands and over 500 sleeves so he claims he has done 1300 bands and 600 sleeves. It simply isn't true.
So read the discussion boards and 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 on various message boards that you are looking for a sleeve surgeon, the patient coordinators are going to come out posting nonstop. These are people that are paid to get you to go to their employer. Some of them have been sleeved 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 from 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, they are probably a coordinator. For example, 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 online. 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 sleeves, everything. It takes many years to build a practice, it does not happen overnight. The practice, the reputation, the works, it takes years. Now keep in mind, this is after they are experienced, established, and have a great reputation. Doctors in Mexico depend on reputation, they do not have insurance companies sending them patients, they have no choice but to do a good job and build their reputation. It happens much more slowly in Mexico (building a reputation) than it does in the US. After someone has been I practice for about 5-7 years, then their procedure stats will start climbing. If someone has been in practice for 2-3 years and claiming big numbers, you know they are making up stories.
Booking Agencies/Medical Tourism Companies
This is another area of consideration. Do you want to deal with a booking agency? Some do, some do not. It comes down to personal preference. Booking agencies are paid to advertise for several doctors, 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. This usually tacks on about $1500 to your surgery price. This is why I suggest going to the surgeons office directly, you can call the office and schedule surgery yourself and save $1500.00. 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. I have yet to see a sincerely ethical medical tourism company. The greater majority of the time they have never even met the surgeon, if he is cheap, owns his own scalpel, and can sign his name on the contract, he's hired. While it is personal choice, please just go through the surgeon's office. YOU find the surgeon, don't depend on someone to choose your surgeon based on the amount of commission they will make. They are going to choose the cheapest surgeon because then they can charge you a bigger commission.
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.
That brings up the topic of which border city. Some are quite safe; some are the most dangerous cities in Mexico. Know where you are going. If there are police officers and army stationed all over with large guns, you might not be in a great city. Mexico has problems with their border towns just like we do in the US.
Hospital or clinic?
There is no way that it is safe to have a sleeve procedure or any WLS surgery in a clinic in Mexico. This is a procedure that carries a bit more risk than other procedures and you really need to be in a hospital. Obese 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 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, it could be hours. The risk for sleeve complications is quite low but it does happen. If it did happen I wanted to already be in a hospital.
One problem with going to Mexico is that most doctors refer to their clinics as hospitals. They refer to a surgical center as a hospital. When you call ask if the "hospital" has a pharmacy, blood bank, ICU, Pediatric ICU, Heart center, specialist available 24/7 such as cardiologists, etc. Ask them if they have a fully equipped radiology department with fluoroscopy, CT equipment, and equipment that would be found in a hospital but not a clinic. If they do not have all this equipment available it is a clinic and not a hospital and they are trying to fool you into thinking they are something they are not.
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 the cost of the staples used on your stomach are far more expensive than you might realize. The cost of the staples alone could very easily be between $2,000 and $3,000 per patient. That is the doctor's cost on that one supply needed during surgery. 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, this is one way to research your doctor. 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 1% 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 online is a great way to get an idea of doctors. 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 50 patient testimonials or talk to at least 50 people about their surgery.
There are four doctors 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 surgery 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, and all she did. She went to the same doctor and ended up with an infection so severe she will lose her Lap Band. I know of two others who went to the same doctor, one for a sleeve and one for DS and both almost died. Had they stayed in that facility a day longer vs. leaving the "clinic" against medical advice, they would have died. It happens all the time and it is not just Mexican doctors that cause infections, it happens in the US. You are not going to all the expense and trouble to have surgery just to lose your health and potentially your life to an unskilled surgeon. Do your research.
Mexico struggles with the same issues as the US in dealing with the bad doctors. People believe that having surgery in the US is safe because it is the US. Not true. In my own city there is a convicted pedophile currently licensed as a pediatrician. I know of three surgeons in my city who were caught intoxicated while operating on their patients, they all received a "Letter of Concern," in their files. That is less than a slap on the hands. Mexico is no different from the US in this case, it is important to research your doctor regardless of which country you are in.
Pre-Op Testing
This is critical to have a safe surgery. You should get AT LEAST a complete blood count, chemistry panel, thyroid profile, 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 do 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 surgery 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
Regarding sleeve procedures there should typically be three tests. They are all leak tests. One isn't really a "post op" leak test, it is a leak test done during surgery. The doctor will fill your stomach with air, fill your abdominal cavity with saline and look for bubbles.
Leak test #2: Methylene Blue. You will have a drain in your incision; they will have you drink a product called Methylene Blue. It looks exactly like blue ink. Your tongue will even turn blue for a few hours after you drink it. The idea is to see if anything blue comes out of your drain.
Leak test #3: Contrast under fluoroscopy. You will drink a product that shows up under fluoroscopy. Fluoroscopy is a moving x-ray and it is critical to have all three of these leak tests before returning to your home. This test will check for micro perforations or tiny "pinhole" leaks that may not show up otherwise.
A very important question for you to ask when researching your surgeon is if the contrast material they will use during your fluoroscopy leak test is barium or a water soluble product. A few doctors pinch pennies by using barium instead of the expensive water soluble (hydro soluble) contrast. The problem is this, if you do have a leak and you drink barium, barium will leak out into your abdominal cavity. This is extremely dangerous. If you have no leak it is not an issue but remember, they are checking for leaks! Until the test is over they do not know if you have one or not.
If you have a leak and you drink barium, the barium will flow out of the leak and into your abdomen. Barium is not absorbed by the body, think of cement. If you have chunks of cement in your abdomen your body would not absorb it like it would saline. So it potentially requires surgical removal. This is a huge surgical procedure that is likely to cause many complications and problems. Infection is a huge problem when barium leaks into the abdominal cavity or peritoneum. This is why it is critical to make sure the doctor uses a water soluble contrast material, if there is a leak the contrast will not harm you the way Barium will harm you.
The only reason for using barium instead of the appropriate product is cost. Barium is much cheaper than the correct products.
Supervision
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 doctors 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 after surgery.
Pre-Op Diets
It is common for doctors to put patients on a pre-op diet before surgery. It is to shrink the liver. The reality is that if someone is on a low-carb, low-fat, and 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. If it is slippery and difficult to manage, it makes it more dangerous for you, so the pre op diet is indeed quite important. Again, it is still quite important to follow the diet for your safety. Some doctors do not require the diet for lower BMI people, others do. It comes down to surgeon preference. Some doctors 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. Your stomach is healing from a major surgical procedure, it needs time to heal before filling it with food that could cause a leak. Leaks are extremely painful and potentially life threatening, if you do not follow the post op diet is it your doctor's fault that you had a leak? Nope, that one will be on you.
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 might return phone calls and emails much faster than 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.
Nude/Semi Nude Photos
Some doctors 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, and 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.
Statistics
You should ask your potential doctor's office about his stats for infection and leaks. 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 urinate 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!
Leaks should also be well under 1%. Ask how many sleeves your doctor has done and how many leaks he has had.
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.
Getting a Vertical Sleeve Gastrectomy/Sleeve Procedure
***It has come to my attention that there is a man in Tijuana, Mexico that is posing as a physician, not a surgeon and no - he is not doing surgery he merely owns the clinic. This man is posing as a physician and he is not a physician. He has never been to medical school, he has no formal medical education. ANYONE that claims to be a physician or surgeon you should verify this through the Mexican Government. You need to obtain the license number of the physician and enter it to the following website. The true owner of the license will show up. There is absolutely no reason any licensed physician would deny you their license number, none!***
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
Surgery in Mexico is handled a bit differently than it is in the United States. 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" Gastric Sleeve procedure. He pays all the other doctors.
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. This is 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. 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.
Choosing a surgeon
Avoid choosing a doctor that nobody has heard of before. There is little need to do that. Why take the risk? Doctors throughout the world have discovered that bariatric surgery has the potential to be extremely profitable. Many physicians are getting in the business, so there are a lot of inexperienced surgeons around. You ONLY want someone who is very experienced. After a bariatric surgeon has done around 250 sleeves 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, etc. So you want to find someone that has done at least 250 sleeve surgeries.
Now, does that mean that someone who has done 500 sleeves is better than someone that has done 250 sleeves? Not exactly. One way to think about it: were you any better at washing dishes the 250th time you did the task vs. the 500th time? That's probably not so. Either you get it or you don't. The same concept applies here.
FACS (Fellow of the American College of Surgeons)
If you do not know how to verify licensing, credentials, education, history, etc., your best bet is to choose a doctor that is a Fellow of the American College of Surgeons. It takes about 8 months for the American College of Surgeons to do their background investigation of a doctor. If they have "FACS" behind their name then they must exceed the requirements for a US physician. Don't bank on what you are told by the coordinators, if they say the doctor is FACS then verify it for yourself. Go to Welcome to the American College of Surgeons and obtain the (800) number from their website and call. Ask them if it is true the doctor you are researching is indeed a Fellow. You can search on their website but their website is often times hard to navigate. It's easier to call them and obtain the information over the phone.
Please note: There are doctors that claim to be FACS and they are not. They are banking that you will not verify this information. Do not take the office staff or MD's word for it that they are FaCS, go to their website and verify for yourself. That website is:
www.FACS.org
If you are unsure call the (800) and ask the FACS staff, they will assist you.
Experience
How long has your doctor been doing sleeves? No, not how long he has been doing bariatric surgery but how long he's been doing sleeves? That is the question you want to ask. Someone can do 4000 lap procedures but that does not mean he has done 4000 sleeves. A doctor can do 4000 lap procedures and they might all be Lap Bands or removing someone's gallbladder. That is not what we are looking for; we are looking for someone very experienced in sleeve issues. We have different needs and requirements than folks who had a Lap Band and the technique is extremely different for various procedures. There is a learning curve to each procedure, and with each procedure the doctors 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?
Many make the mistake of thinking that they really "like" their doctor and they bank on personality instead of skill. This is a major mistake.
Find someone who has done *at least* 250 sleeves AND 250 Gastric Bypass procedures. The Bypass staple line is quite difficult to do and not everyone can do it. It can't be over sewn or secured so it takes great skill to do this type of staple line. If someone can do a bypass staple line without problems then they should be fine with a sleeve staple line. If they can't do a difficult bypass staple line then do you want them doing any staple line on you?
Skill
We should discuss skill. Banding is the easiest surgical bariatric procedure to do. Yes, there is a learning curve; however, after the learning curve it is without a doubt the easiest procedure to do. That is why so many new doctors what a piece of the action. After they do a few bands they decide to start getting into the trickier procedures such as bypass and sleeves.
Can your potential doctor do the hard stuff too? Can they do gastric bypass? Duodenal switch (DS)? Can they do revisions such as bypass to banding? Many bypass procedures fail and the patient regains their weight. Band after bypass 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 doctors do not do all the tricky procedures, they just don't have the training, skill, or experience so they stick with less complicated procedures. My personal preference is to have someone that can do it all, even the difficult and tricky procedures. Some don't care, they just want a sleeve 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 sleeves has a doctor really done? I know of one in Mexico that has done less than 200-300 sleeves, yet he claims astronomical numbers on his website. Doctors 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 100 sleeves 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 300 bands and 300 sleeves yet his partner has done over 5000 bands and over 500 sleeves so he claims he has done 1300 bands and 600 sleeves. It simply isn't true.
So read the discussion boards and 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 on various message boards that you are looking for a sleeve surgeon, the patient coordinators are going to come out posting nonstop. These are people that are paid to get you to go to their employer. Some of them have been sleeved 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 from 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, they are probably a coordinator. For example, 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 online. 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 sleeves, everything. It takes many years to build a practice, it does not happen overnight. The practice, the reputation, the works, it takes years. Now keep in mind, this is after they are experienced, established, and have a great reputation. Doctors in Mexico depend on reputation, they do not have insurance companies sending them patients, they have no choice but to do a good job and build their reputation. It happens much more slowly in Mexico (building a reputation) than it does in the US. After someone has been I practice for about 5-7 years, then their procedure stats will start climbing. If someone has been in practice for 2-3 years and claiming big numbers, you know they are making up stories.
Booking Agencies/Medical Tourism Companies
This is another area of consideration. Do you want to deal with a booking agency? Some do, some do not. It comes down to personal preference. Booking agencies are paid to advertise for several doctors, 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. This usually tacks on about $1500 to your surgery price. This is why I suggest going to the surgeons office directly, you can call the office and schedule surgery yourself and save $1500.00. 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. I have yet to see a sincerely ethical medical tourism company. The greater majority of the time they have never even met the surgeon, if he is cheap, owns his own scalpel, and can sign his name on the contract, he's hired. While it is personal choice, please just go through the surgeon's office. YOU find the surgeon, don't depend on someone to choose your surgeon based on the amount of commission they will make. They are going to choose the cheapest surgeon because then they can charge you a bigger commission.
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.
That brings up the topic of which border city. Some are quite safe; some are the most dangerous cities in Mexico. Know where you are going. If there are police officers and army stationed all over with large guns, you might not be in a great city. Mexico has problems with their border towns just like we do in the US.
Hospital or clinic?
There is no way that it is safe to have a sleeve procedure or any WLS surgery in a clinic in Mexico. This is a procedure that carries a bit more risk than other procedures and you really need to be in a hospital. Obese 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 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, it could be hours. The risk for sleeve complications is quite low but it does happen. If it did happen I wanted to already be in a hospital.
One problem with going to Mexico is that most doctors refer to their clinics as hospitals. They refer to a surgical center as a hospital. When you call ask if the "hospital" has a pharmacy, blood bank, ICU, Pediatric ICU, Heart center, specialist available 24/7 such as cardiologists, etc. Ask them if they have a fully equipped radiology department with fluoroscopy, CT equipment, and equipment that would be found in a hospital but not a clinic. If they do not have all this equipment available it is a clinic and not a hospital and they are trying to fool you into thinking they are something they are not.
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 the cost of the staples used on your stomach are far more expensive than you might realize. The cost of the staples alone could very easily be between $2,000 and $3,000 per patient. That is the doctor's cost on that one supply needed during surgery. 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, this is one way to research your doctor. 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 1% 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 online is a great way to get an idea of doctors. 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 50 patient testimonials or talk to at least 50 people about their surgery.
There are four doctors 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 surgery 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, and all she did. She went to the same doctor and ended up with an infection so severe she will lose her Lap Band. I know of two others who went to the same doctor, one for a sleeve and one for DS and both almost died. Had they stayed in that facility a day longer vs. leaving the "clinic" against medical advice, they would have died. It happens all the time and it is not just Mexican doctors that cause infections, it happens in the US. You are not going to all the expense and trouble to have surgery just to lose your health and potentially your life to an unskilled surgeon. Do your research.
Mexico struggles with the same issues as the US in dealing with the bad doctors. People believe that having surgery in the US is safe because it is the US. Not true. In my own city there is a convicted pedophile currently licensed as a pediatrician. I know of three surgeons in my city who were caught intoxicated while operating on their patients, they all received a "Letter of Concern," in their files. That is less than a slap on the hands. Mexico is no different from the US in this case, it is important to research your doctor regardless of which country you are in.
Pre-Op Testing
This is critical to have a safe surgery. You should get AT LEAST a complete blood count, chemistry panel, thyroid profile, 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 do 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 surgery 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
Regarding sleeve procedures there should typically be three tests. They are all leak tests. One isn't really a "post op" leak test, it is a leak test done during surgery. The doctor will fill your stomach with air, fill your abdominal cavity with saline and look for bubbles.
Leak test #2: Methylene Blue. You will have a drain in your incision; they will have you drink a product called Methylene Blue. It looks exactly like blue ink. Your tongue will even turn blue for a few hours after you drink it. The idea is to see if anything blue comes out of your drain.
Leak test #3: Contrast under fluoroscopy. You will drink a product that shows up under fluoroscopy. Fluoroscopy is a moving x-ray and it is critical to have all three of these leak tests before returning to your home. This test will check for micro perforations or tiny "pinhole" leaks that may not show up otherwise.
A very important question for you to ask when researching your surgeon is if the contrast material they will use during your fluoroscopy leak test is barium or a water soluble product. A few doctors pinch pennies by using barium instead of the expensive water soluble (hydro soluble) contrast. The problem is this, if you do have a leak and you drink barium, barium will leak out into your abdominal cavity. This is extremely dangerous. If you have no leak it is not an issue but remember, they are checking for leaks! Until the test is over they do not know if you have one or not.
If you have a leak and you drink barium, the barium will flow out of the leak and into your abdomen. Barium is not absorbed by the body, think of cement. If you have chunks of cement in your abdomen your body would not absorb it like it would saline. So it potentially requires surgical removal. This is a huge surgical procedure that is likely to cause many complications and problems. Infection is a huge problem when barium leaks into the abdominal cavity or peritoneum. This is why it is critical to make sure the doctor uses a water soluble contrast material, if there is a leak the contrast will not harm you the way Barium will harm you.
The only reason for using barium instead of the appropriate product is cost. Barium is much cheaper than the correct products.
Supervision
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 doctors 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 after surgery.
Pre-Op Diets
It is common for doctors to put patients on a pre-op diet before surgery. It is to shrink the liver. The reality is that if someone is on a low-carb, low-fat, and 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. If it is slippery and difficult to manage, it makes it more dangerous for you, so the pre op diet is indeed quite important. Again, it is still quite important to follow the diet for your safety. Some doctors do not require the diet for lower BMI people, others do. It comes down to surgeon preference. Some doctors 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. Your stomach is healing from a major surgical procedure, it needs time to heal before filling it with food that could cause a leak. Leaks are extremely painful and potentially life threatening, if you do not follow the post op diet is it your doctor's fault that you had a leak? Nope, that one will be on you.
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 might return phone calls and emails much faster than 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.
Nude/Semi Nude Photos
Some doctors 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, and 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.
Statistics
You should ask your potential doctor's office about his stats for infection and leaks. 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 urinate 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!
Leaks should also be well under 1%. Ask how many sleeves your doctor has done and how many leaks he has had.
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.
Subscribe to:
Posts (Atom)