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.
Showing posts with label Surgeons. Show all posts
Showing posts with label Surgeons. Show all posts
Monday, March 22, 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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