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.
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.
Saturday, March 20, 2010
Helpful Links For WLS Folks
Here are some links, all kinds of links. I am sorry they are not in link version but for some reason the software will not let me make them into links so you'll have to copy and paste to your browser before they will work.
Please please bookmark this site, this is a site that updates all the studies being done on obesity today. Read daily and keep up to date on the new science behind obesity, I will attempt to add an RSS feeder to this blog if you prefer to read the studies here:
http://www.medicalnewstoday.com/sections/fitness-obesity/
This is the same as the above only on nutrition:
http://www.medicalnewstoday.com/sections/nutrition-agriculture/
The following link is merely out of respect, a very dear banded friend of mine passed away from esophageal cancer, nothing in the world to do with her WLS. But out of respect I would like to post her blog:
http://www.scentednectar.com/sneerfactor/
A McDonalds Hamburger - This will show you that Mickey D's is not food, I don't know what it is but it is not food:
http://www.youtube.com/watch?v=4IGtDPG4UfI&feature=channel_page
A friend of mine started a WLS forum, he couldn't make a go of it but he let me take it over and we use it for chit chat. The mods there are me, Elisabethsew from LBT and VST, and MacMadame from OH:
www.wlsfacts.com
Calculate your BMI:
http://nhlbisupport.com/bmi/bmicalc.htm
Calculate your BMR:
http://www.bmi-calculator.net/bmr-calculator/
Why do some of us lose hair after surgery? Here is the explanation:
http://emedicine.medscape.com/article/1071566-overview
This is a recipe forum where you enter the ingredients you have and then you can find recipes for what you already have in your house:
http://emedicine.medscape.com/article/1071566-overview
American College of Surgeons:
www.FACS.org
American Society for Metabolic & Bariatric Surgery:
www.ASMBS.org
5 Day Pouch Test:
http://www.5daypouchtest.com/
My Favorite place to buy protein products and various supplies:
www.netrition.com
A great source to tell you everything you ever wanted to know about specific food items. You can enter a recipe here and it will make a complete food label for your entire recipe:
www.nutritiondata.com
Some sites to track your food and weight:
www.TheDailyPlate.com
www.FitDay.com
www.SparkPeople.com
A US Government Website where you can find various clinical trials:
http://clinicaltrials.gov/
This study changed the way the world of medicine looks at diabetes:
http://www.medicalnewstoday.com/articles/72982.php
Here is a detailed weight graph for those of us who obsess over weight (However, I use www.TheDailyPlate.com):
http://www.thinnerself.com/files/Expect_Chart.htm
The Scoop on Poop, things change, colors change, this explains your pooh:
http://www.heptune.com/poop.html
Why TUMS and Rolaids are not great for reflux symptoms:
http://ezinearticles.com/?Acid-Rebound,-Acid-Reflux-And-Your-Health&id=761343
What is Ghrelin?
http://www.wisegeek.com/what-is-ghrelin.htm
Surgery types explained:
http://www.asbs.org/html/patients/gastroplasty.html
Vit D Council (you can order a test kit to test your own Vit D levels here):
http://www.vitamindcouncil.org/
Gastric Emptying explained:
http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/emptying.html
Information on obtaining a passport if you choose to leave the country for surgery:
http://travel.state.gov/passport/get/fees/fees_837.html
What will you look like as you lose weight? Upload your photo and see!
http://www0.weightmirror.com/weightmirror/index.php?id
Comparing RNY and DS;
http://www.dsfacts.com/Comparison-of-DS-and-RNY.html
Weight Loss Plateaus explained:
http://www.weightwatchers.com/util/art/index_art.aspx?tabnum=1&art_id=23561
Bariatric Revision surgery video:
http://www.orlive.com/ethiconendo-surgery/videos/bariatric-revision-surgery?cmpid=ens_2539_adwords&gclid=CMnur9_ZqZ8CFRwTagodJTcW0w
Please please bookmark this site, this is a site that updates all the studies being done on obesity today. Read daily and keep up to date on the new science behind obesity, I will attempt to add an RSS feeder to this blog if you prefer to read the studies here:
http://www.medicalnewstoday.com/sections/fitness-obesity/
This is the same as the above only on nutrition:
http://www.medicalnewstoday.com/sections/nutrition-agriculture/
The following link is merely out of respect, a very dear banded friend of mine passed away from esophageal cancer, nothing in the world to do with her WLS. But out of respect I would like to post her blog:
http://www.scentednectar.com/sneerfactor/
A McDonalds Hamburger - This will show you that Mickey D's is not food, I don't know what it is but it is not food:
http://www.youtube.com/watch?v=4IGtDPG4UfI&feature=channel_page
A friend of mine started a WLS forum, he couldn't make a go of it but he let me take it over and we use it for chit chat. The mods there are me, Elisabethsew from LBT and VST, and MacMadame from OH:
www.wlsfacts.com
Calculate your BMI:
http://nhlbisupport.com/bmi/bmicalc.htm
Calculate your BMR:
http://www.bmi-calculator.net/bmr-calculator/
Why do some of us lose hair after surgery? Here is the explanation:
http://emedicine.medscape.com/article/1071566-overview
This is a recipe forum where you enter the ingredients you have and then you can find recipes for what you already have in your house:
http://emedicine.medscape.com/article/1071566-overview
American College of Surgeons:
www.FACS.org
American Society for Metabolic & Bariatric Surgery:
www.ASMBS.org
5 Day Pouch Test:
http://www.5daypouchtest.com/
My Favorite place to buy protein products and various supplies:
www.netrition.com
A great source to tell you everything you ever wanted to know about specific food items. You can enter a recipe here and it will make a complete food label for your entire recipe:
www.nutritiondata.com
Some sites to track your food and weight:
www.TheDailyPlate.com
www.FitDay.com
www.SparkPeople.com
A US Government Website where you can find various clinical trials:
http://clinicaltrials.gov/
This study changed the way the world of medicine looks at diabetes:
http://www.medicalnewstoday.com/articles/72982.php
Here is a detailed weight graph for those of us who obsess over weight (However, I use www.TheDailyPlate.com):
http://www.thinnerself.com/files/Expect_Chart.htm
The Scoop on Poop, things change, colors change, this explains your pooh:
http://www.heptune.com/poop.html
Why TUMS and Rolaids are not great for reflux symptoms:
http://ezinearticles.com/?Acid-Rebound,-Acid-Reflux-And-Your-Health&id=761343
What is Ghrelin?
http://www.wisegeek.com/what-is-ghrelin.htm
Surgery types explained:
http://www.asbs.org/html/patients/gastroplasty.html
Vit D Council (you can order a test kit to test your own Vit D levels here):
http://www.vitamindcouncil.org/
Gastric Emptying explained:
http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/emptying.html
Information on obtaining a passport if you choose to leave the country for surgery:
http://travel.state.gov/passport/get/fees/fees_837.html
What will you look like as you lose weight? Upload your photo and see!
http://www0.weightmirror.com/weightmirror/index.php?id
Comparing RNY and DS;
http://www.dsfacts.com/Comparison-of-DS-and-RNY.html
Weight Loss Plateaus explained:
http://www.weightwatchers.com/util/art/index_art.aspx?tabnum=1&art_id=23561
Bariatric Revision surgery video:
http://www.orlive.com/ethiconendo-surgery/videos/bariatric-revision-surgery?cmpid=ens_2539_adwords&gclid=CMnur9_ZqZ8CFRwTagodJTcW0w
Friday, March 19, 2010
Insurance Hoops - Surviving the Insanity!
Congratulations! You are ready to have surgery. You have decided on a surgery type, you have picked your surgeon, now comes the insurance hoops to jump though for those going through insurance.
Some insurance companies offer limited surgery types. Some will only pay for bands and bypass. Some will only pay for sleeves or DS if your BMI is over 50. What if you want a sleeve and your insurance will only pay for bands and bypass?
APPEAL APPEAL APPEAL!
It isn't a sure bet that your insurance will approve an appeal but what do you have to lose?
Now, every insurance company I have looked into and researched require a BMI of 40 or greater to be approved for weight loss surgery. Most will accept your 35 BMI *if* you have very specific comorbidities. Typically they want to see active high blood pressure, diabetes, sleep apnea, and/or a history of heart disease. Although we have a poor quality of life with back pain, joint damage, an inability to breathe well, borderline high blood pressure, pre diabetes, asthma... those just don't count. They are typically very specific which cormorbidities they require for a BMI of 35 - 39.9.
What if you have high blood pressure but it is controlled with diet alone? No, it does not usually count.
What if you are pre-diabetic? No, it does not usually count.
What if you have a family history of strokes, diabetes, high blood pressure, and/or sleep apnea? No, that does not count.
You have to be actively treated for these things by a doctor with medications and such before the insurance company will consider them comorbidities. Remember, insurance companies are not strong in common sense. You have to think like them to understand them. Yes, they would prefer to pay for your heart attacks, dialysis, and other related expenses than to pay for your weight loss surgery if it is something they do not cover. They act like a computer, computers do not think, they just spit out information. Computers follow rules, they have no common sense. They don't look at the best value for a dollar spent. Information in, information out. That is exactly what an insurance company does. Some people write long letters to the insurance company begging and pleading for coverage when they do not qualify for some reason. It does not matter. The insurance company (think computer) does not care about you as a human being that is sick and miserable. They care if your blood pressure is high enough and if you are obese enough. If the numbers add up they will pay for your surgery. I know it is not right and it is not ethical, but this is how it works so you will do better for yourself to accept this is how it works and approach it from the right angle. No, life is not fair and no, it is not right but they call the shots and they usually get to have their own way.
What if you want DS but your insurance pays for bypass or bands? Many think if they need NSAIDs (Aspirin, Naprosyn, Motrin, etc.) they can appeal based on this since you cannot take NSAIDs with bypass. They will likely deny you because they do offer bands and you can take NSAIDs with bands. (History: It used to be that doctors thought NSAIDs could not be taken by band patients due to causing erosion, that has since been shown to be inaccurate, NSAIDs do not cause erosion in banded people.)
I recall one person that was just sure he could get a non-covered sleeve on appeal based on the fact that he is deficient in Vitamin D. That is a no-go as well. Most of the US population is low on Vitamin D. Supplements will bring it up and therefore if they cover bands and bypass, they are good to go. Keeping in mind that many times the number of times you may appeal are limited, don't waste your appeals on what you know isn't going to work.
What if you weigh 900# and you have no benefits for WLS? You are out of luck. Yes, once again the insurance companies would rather pay the hundreds of thousands of dollars to treat what weight loss surgery would fix.
Many (most?) insurance companies will not pay for sleeves. They consider the procedure to be investigational. The ASMBS disagrees and they no longer consider the procedure investigational. Let's realize one issue here, the sleeve is not new! The weight loss stats are new, not the surgery itself. With some insurance companies - some of the time - you can appeal and get a sleeve by proving it is not investigational. Once Medicare starts paying for sleeves then you will see more insurance companies beginning to follow suit as well.
What if they require a medically supervised diet for 3-6 months? How does that work?
It really depends on the wording of the insurance company. If they want a "medically supervised" diet they want you going to your doctor and/or nutritionist monthly. They want documentation of effort on your part to try and change eating behaviors, exercise, and sometimes psych care to treat a "medical" problem of obesity. (I know, that doesn't usually make sense either, it's like going to your psych for your diabetes!) They want to make sure that every 25-30 days you have been to your appointments. Not 32 days but 30 days. They want your medical provider to document your weight, the change in weight from the previous month, and written data showing they worked with you on diet and exercise.
If they do not specify "Medically Supervised" then they probably mean something like Weight Watchers, Jenny Craig, some sort of proof that you tried and participated for 6 months. Ask your insurance company and if your policy is not clear make them put it in writing.
What if your insurance company wants proof that you have been a specific BMI or greater for the last five years? If you are anything like most, most of us have dodged doctor's scales for years. It might not be in your medical records what your weight was so be creative! What does your weight say on your drivers license? Okay, if you are like most you are at or near your heaviest today but you still show 150# on your license. But, if you told the truth on your license and it shows your BMI is what is required, that can be put toward proof for that year.
Photographs! Some photos are dated by an outside source (other than your digital camera) such as Walgreen's Photo Dept. If it is obvious from dated photos that you met the BMI requirements, that can often times be used as well.
Emergency Room visits - think back to anytime you might have needed to go to the hospital for sutures or a broken bone. They usually insist on weighing you. Those records can be used to prove BMI requirements.
Be creative and find whatever is necessary to prove your BMI if you do not have proof at your MD office.
What if you lose weight on the supervised diet and fall below the required BMI? You are safe. If you met all the BMI requirements in the beginning of the insurance approval process it is okay if you fall below on the required diet. Can you imagine the lawsuits otherwise? They require you to lose weight to prove your mind is made up and this is what you want then they deny you because you did exactly as you were instructed. Lose weight on your pre op diet, it's safer for you at the time of surgery.
Usually you have to meet other requirements that are equally silly to have insurance pay for your weight loss surgery. They want you to go to a bariatric surgeon for an eval. They may want you to see a psychologist to see if you are mentally prepared for surgery, this is just an eval and not an on-going therapy process. If they suggest you need therapy before surgery ask if you are required to go to them for your therapy before they will approve you. It *might* be a way to force you to continue going back for sessions just to pad their pockets. This does not happen often but it does happen. If you want you can always get a 2nd opinion.
They want you to do a sleep study to see if you have Sleep Apnea and this is something weight loss is likely to fix anyway. They want you to see a nutritionist for an eval prior to surgery. This one annoys me as most nutritionists do not have a huge base of knowledge on weight loss surgery. They will tell people to eat far more calories than possible after surgery. All surgery types limit quantity of food. Just how are you supposed to eat 1800 calories a day with a stomach the size of a ping pong ball? Top that off with their instructions NOT to drink your calories and you see my point. They have more training in people that have specific medical conditions such as wheat allergies, need a gluten free diet, etc. Sometimes they may not understand our issues. If you can go to a nutritionist that is also a WLS patient, all the better.
Many nutritionists will give you a diet for bypass but if you have other surgery types, it doesn't work. For example, DS patients NEED and REQUIRE a very high fat diet but their instructions are likely to stay on a low fat diet. DS folks malabsorb 80% of their fat intake and to keep losing weight they absolutely must eat a high fat diet. I can give you many examples but my advice to you is to ask for a combination of what you should eat. What percentage of your daily food should be carbs, protein, and fat? Listen to your doctor and not your NUT (nutritionist) about caloric requirements. Ask how many grams of protein you should be consuming daily. But again, ask your doctor about caloric requirements.
Dealing with insurance companies is no easy task. Some insurance companies are easier to deal with than others. If all else fails, have your surgeon do a peer to peer review with them. That means your surgeons sets an appointment with the doctor at your insurance company and he explains why you must have "X" surgery type instead of what they say they will pay for.
**NOTE: Regarding peer to peer reviews, this is a LAST option. Do not use this for your 1st or 2nd appeal or you *will* be denied. Insurance companies do not want their doctor tied up doing what the appeals department should be doing. So use it as a last and final option.
If that fails you have one more option. Seek the advice of an attorney. There is one attorney that does nothing but this type of work. It seems somewhat affordable and they appear to have a good track record. I prefer not to advertise specific businesses that I have no personal experience with but you can go to www.obesityhelp.com and post most anywhere asking for this man's name and you will get your answer. I would not suggest contacting your family attorney as he does not likely specialize in this and he doesn't know the ins and outs of insurance companies and weight loss surgery. It may end up being far more expensive going through your own attorney just because he may need to take more steps and charge you for each step until he finds the correct appeal paperwork. But clearly, this is your choice.
Some insurance companies offer limited surgery types. Some will only pay for bands and bypass. Some will only pay for sleeves or DS if your BMI is over 50. What if you want a sleeve and your insurance will only pay for bands and bypass?
APPEAL APPEAL APPEAL!
It isn't a sure bet that your insurance will approve an appeal but what do you have to lose?
Now, every insurance company I have looked into and researched require a BMI of 40 or greater to be approved for weight loss surgery. Most will accept your 35 BMI *if* you have very specific comorbidities. Typically they want to see active high blood pressure, diabetes, sleep apnea, and/or a history of heart disease. Although we have a poor quality of life with back pain, joint damage, an inability to breathe well, borderline high blood pressure, pre diabetes, asthma... those just don't count. They are typically very specific which cormorbidities they require for a BMI of 35 - 39.9.
What if you have high blood pressure but it is controlled with diet alone? No, it does not usually count.
What if you are pre-diabetic? No, it does not usually count.
What if you have a family history of strokes, diabetes, high blood pressure, and/or sleep apnea? No, that does not count.
You have to be actively treated for these things by a doctor with medications and such before the insurance company will consider them comorbidities. Remember, insurance companies are not strong in common sense. You have to think like them to understand them. Yes, they would prefer to pay for your heart attacks, dialysis, and other related expenses than to pay for your weight loss surgery if it is something they do not cover. They act like a computer, computers do not think, they just spit out information. Computers follow rules, they have no common sense. They don't look at the best value for a dollar spent. Information in, information out. That is exactly what an insurance company does. Some people write long letters to the insurance company begging and pleading for coverage when they do not qualify for some reason. It does not matter. The insurance company (think computer) does not care about you as a human being that is sick and miserable. They care if your blood pressure is high enough and if you are obese enough. If the numbers add up they will pay for your surgery. I know it is not right and it is not ethical, but this is how it works so you will do better for yourself to accept this is how it works and approach it from the right angle. No, life is not fair and no, it is not right but they call the shots and they usually get to have their own way.
What if you want DS but your insurance pays for bypass or bands? Many think if they need NSAIDs (Aspirin, Naprosyn, Motrin, etc.) they can appeal based on this since you cannot take NSAIDs with bypass. They will likely deny you because they do offer bands and you can take NSAIDs with bands. (History: It used to be that doctors thought NSAIDs could not be taken by band patients due to causing erosion, that has since been shown to be inaccurate, NSAIDs do not cause erosion in banded people.)
I recall one person that was just sure he could get a non-covered sleeve on appeal based on the fact that he is deficient in Vitamin D. That is a no-go as well. Most of the US population is low on Vitamin D. Supplements will bring it up and therefore if they cover bands and bypass, they are good to go. Keeping in mind that many times the number of times you may appeal are limited, don't waste your appeals on what you know isn't going to work.
What if you weigh 900# and you have no benefits for WLS? You are out of luck. Yes, once again the insurance companies would rather pay the hundreds of thousands of dollars to treat what weight loss surgery would fix.
Many (most?) insurance companies will not pay for sleeves. They consider the procedure to be investigational. The ASMBS disagrees and they no longer consider the procedure investigational. Let's realize one issue here, the sleeve is not new! The weight loss stats are new, not the surgery itself. With some insurance companies - some of the time - you can appeal and get a sleeve by proving it is not investigational. Once Medicare starts paying for sleeves then you will see more insurance companies beginning to follow suit as well.
What if they require a medically supervised diet for 3-6 months? How does that work?
It really depends on the wording of the insurance company. If they want a "medically supervised" diet they want you going to your doctor and/or nutritionist monthly. They want documentation of effort on your part to try and change eating behaviors, exercise, and sometimes psych care to treat a "medical" problem of obesity. (I know, that doesn't usually make sense either, it's like going to your psych for your diabetes!) They want to make sure that every 25-30 days you have been to your appointments. Not 32 days but 30 days. They want your medical provider to document your weight, the change in weight from the previous month, and written data showing they worked with you on diet and exercise.
If they do not specify "Medically Supervised" then they probably mean something like Weight Watchers, Jenny Craig, some sort of proof that you tried and participated for 6 months. Ask your insurance company and if your policy is not clear make them put it in writing.
What if your insurance company wants proof that you have been a specific BMI or greater for the last five years? If you are anything like most, most of us have dodged doctor's scales for years. It might not be in your medical records what your weight was so be creative! What does your weight say on your drivers license? Okay, if you are like most you are at or near your heaviest today but you still show 150# on your license. But, if you told the truth on your license and it shows your BMI is what is required, that can be put toward proof for that year.
Photographs! Some photos are dated by an outside source (other than your digital camera) such as Walgreen's Photo Dept. If it is obvious from dated photos that you met the BMI requirements, that can often times be used as well.
Emergency Room visits - think back to anytime you might have needed to go to the hospital for sutures or a broken bone. They usually insist on weighing you. Those records can be used to prove BMI requirements.
Be creative and find whatever is necessary to prove your BMI if you do not have proof at your MD office.
What if you lose weight on the supervised diet and fall below the required BMI? You are safe. If you met all the BMI requirements in the beginning of the insurance approval process it is okay if you fall below on the required diet. Can you imagine the lawsuits otherwise? They require you to lose weight to prove your mind is made up and this is what you want then they deny you because you did exactly as you were instructed. Lose weight on your pre op diet, it's safer for you at the time of surgery.
Usually you have to meet other requirements that are equally silly to have insurance pay for your weight loss surgery. They want you to go to a bariatric surgeon for an eval. They may want you to see a psychologist to see if you are mentally prepared for surgery, this is just an eval and not an on-going therapy process. If they suggest you need therapy before surgery ask if you are required to go to them for your therapy before they will approve you. It *might* be a way to force you to continue going back for sessions just to pad their pockets. This does not happen often but it does happen. If you want you can always get a 2nd opinion.
They want you to do a sleep study to see if you have Sleep Apnea and this is something weight loss is likely to fix anyway. They want you to see a nutritionist for an eval prior to surgery. This one annoys me as most nutritionists do not have a huge base of knowledge on weight loss surgery. They will tell people to eat far more calories than possible after surgery. All surgery types limit quantity of food. Just how are you supposed to eat 1800 calories a day with a stomach the size of a ping pong ball? Top that off with their instructions NOT to drink your calories and you see my point. They have more training in people that have specific medical conditions such as wheat allergies, need a gluten free diet, etc. Sometimes they may not understand our issues. If you can go to a nutritionist that is also a WLS patient, all the better.
Many nutritionists will give you a diet for bypass but if you have other surgery types, it doesn't work. For example, DS patients NEED and REQUIRE a very high fat diet but their instructions are likely to stay on a low fat diet. DS folks malabsorb 80% of their fat intake and to keep losing weight they absolutely must eat a high fat diet. I can give you many examples but my advice to you is to ask for a combination of what you should eat. What percentage of your daily food should be carbs, protein, and fat? Listen to your doctor and not your NUT (nutritionist) about caloric requirements. Ask how many grams of protein you should be consuming daily. But again, ask your doctor about caloric requirements.
Dealing with insurance companies is no easy task. Some insurance companies are easier to deal with than others. If all else fails, have your surgeon do a peer to peer review with them. That means your surgeons sets an appointment with the doctor at your insurance company and he explains why you must have "X" surgery type instead of what they say they will pay for.
**NOTE: Regarding peer to peer reviews, this is a LAST option. Do not use this for your 1st or 2nd appeal or you *will* be denied. Insurance companies do not want their doctor tied up doing what the appeals department should be doing. So use it as a last and final option.
If that fails you have one more option. Seek the advice of an attorney. There is one attorney that does nothing but this type of work. It seems somewhat affordable and they appear to have a good track record. I prefer not to advertise specific businesses that I have no personal experience with but you can go to www.obesityhelp.com and post most anywhere asking for this man's name and you will get your answer. I would not suggest contacting your family attorney as he does not likely specialize in this and he doesn't know the ins and outs of insurance companies and weight loss surgery. It may end up being far more expensive going through your own attorney just because he may need to take more steps and charge you for each step until he finds the correct appeal paperwork. But clearly, this is your choice.
Thursday, March 18, 2010
Why Do We Kill Ourselves With Food? Evil Head Stuff!
I think this is a question we all ask at one time or another. Why DO we do it?
Most newbies firmly believe we eat this way because of a food addiction. I don't know, perhaps that is true. I think as a post op weight loss surgery patient when we come across times when we turn to food and we can no longer eat the way we used to it is a bit of a wake up call. Perhaps someone makes you very angry and you pull out that extra yummy something you pretend you forgot about in the freezer and you start munching. After your very few bites nothing more will fit in that ping pong ball size stomach you have as a newbie post op and you realize - you aren't done. You are not physically hungry, matter of fact you are pretty darn full but you want more food anyway. What's up with that?
Or maybe you are stressed, your boss screamed at you today and if anyone cared to know the truth your boss is a putz and does not have a clue what he is doing. You turn to food and guess what? You eat your few bites of food and you are too full to eat more but you want more anyway.
Some people deal with emotions by eating. At the time we are eating the scary fats and carbs we justify it:
~I had a REALLY bad day today and I just do not care!
~My boss is an idiot, everyone knows it but nobody does anything about it!
~I do not feel well, everyone knows you feed a cold - or do you?
~I am depressed, I deserve a little treat!
~I already screwed up today with carbs so I'll get back on track tomorrow. Since I already blew it for the day I might as well go for it! Where's the cake?
Do any of these sound familiar? It really is true that the hardest part of weight loss surgery is not the surgery, it is the head stuff that goes along with it. For the first time in your life you are forced by sheer nature of the beast to confront your food demons. When you reach for that scrumptious food item and cannot eat enough to fix whatever is wrong, your issues are staring you in the face. I think it is normal to have a little denial at first and you ignore the food monster staring at you and you keep searching the kitchen looking for something that will fit in your stomach but... nothing is there. Frustration sets in and you swear you are hungry even though one more bite of food and you will be hugging your porcelain friend.
It is this crazy insane cycle that has to happen a few times before we begin to really "get" it. You notice a pattern that cannot be denied anymore. You feel stress, you eat. You feel sadness, you eat. You feel anger, you eat. You feel boredom, you eat. Patterns, but no real answers. Right?
There are a number of self help books out there, some great and some not so great. Everyone has their own take on the fix for our issues. I found a book I like and I will tell you why. It doesn't tell you of the horrors of eating food animals, it does not use aversion therapy, it does not give you one fad diet after another promising a forever cure to the disease of obesity. This one is not a diet, not a promise of a quick fix but instead more of a cognitive therapy approach. It is a set of daily exercises (mental and written, not physical) for six weeks. She writes what I call positive affirmations but she calls it a change in the way you are thinking. She's the PhD so she is probably correct! The book is:
"The Beck Diet Solution Weight Loss Workbook"
She has two books, one is a workbook and one is not. I suggest the non-workbook for pre ops and the workbook version for post ops. You honestly do not need both. Oh, you can buy both of them but I think you will find you are wasting your money.
In this book she has you change negative thinking to positive thinking but more important (at least to me) is you end up learning why you do what you do. You have written exercises, you have daily schedules to complete, food logs, columns to compare, and thinking to do. Not only do you face your demons you learn new coping methods. You learn to face your own behaviors and find alternative ways to cope. Really, a big part of this whole thing is being honest with yourself when you are eating for emotion instead of eating for nourishment. When you are eating because you found a way to justify it instead of when you are eating because your body needs fuel.
A big shocker for many is to understand a few key points here.
We can feel hungry, we can feel satisfied, and we can feel full. We are always looking for that full feeling. Thanksgiving Day full, feels so miserably good. Right? Did you know naturally thin people do not want to have that full feeling? They are very content with satisfied, or not hungry. It is us, our population that wants to be in misery we are so full. And in an hour we will do it again! How crazy are we? Well, we aren't crazy. We have a disease and that disease is called obesity.
A really good place to order this book is:
www.ADDall.com >> used and out of print books >> insert author name "Beck" >> insert title
This site is great because it combines ebay, Amazon, and 20,000 private sellers and this book is listed all the time by many sellers so you get to pick your price. As of this morning the book version was $1.41 USD and the workbook version was $6.00 USD. They have US sellers, Canadian sellers, and European sellers. Pick your country and pick your price. Although the books are listed as used most of them are actually new.
Another book people seem to like however I have not read it is:
"Good Calories, Bad Calories" by Gary Taubes.
Go to Amazon.com and read a few pages of each book and see what hits home for you.
Now, there is another reason some people eat the way we do and this is my own personal demon. OCD. Obsessive Compulsive Disorder. It is really the only area OCD seems to affect me, food. When I am stressed or frustrated I absolutely obsess over food. I think about it non stop and while I am eating I think about what I can eat when there is room in my banana sized stomach. I do not experience this all the time, just stages. I can go for weeks and it does not seem to kick in and all the sudden it is there full force. I look up recipes, I look at menus for various restaurants on line, I go to Recipekey.com where I can put ingredients I already have in my kitchen and it will give me recipes where I do not have to go to the store.
This is when I start taking Effexor. I am supposed to take it all the time and I do not. I take it for a couple of weeks here and there. This is what works for me. It kills my head hunger. My stomach rarely feels hungry due to the surgery type I have but my head goes through stages where it insists my stomach wants food.
I am very sure that I am not the only one out there that obsesses over food. I have talked to so many people that have the same issues and if it is indeed OCD, the medications can work quite well. If you feel this is your issue as well I suggest you talk to your doctor. Some are willing to let you try pharmaceuticals and some are not. Just find what is right for you and go for it!
Most newbies firmly believe we eat this way because of a food addiction. I don't know, perhaps that is true. I think as a post op weight loss surgery patient when we come across times when we turn to food and we can no longer eat the way we used to it is a bit of a wake up call. Perhaps someone makes you very angry and you pull out that extra yummy something you pretend you forgot about in the freezer and you start munching. After your very few bites nothing more will fit in that ping pong ball size stomach you have as a newbie post op and you realize - you aren't done. You are not physically hungry, matter of fact you are pretty darn full but you want more food anyway. What's up with that?
Or maybe you are stressed, your boss screamed at you today and if anyone cared to know the truth your boss is a putz and does not have a clue what he is doing. You turn to food and guess what? You eat your few bites of food and you are too full to eat more but you want more anyway.
Some people deal with emotions by eating. At the time we are eating the scary fats and carbs we justify it:
~I had a REALLY bad day today and I just do not care!
~My boss is an idiot, everyone knows it but nobody does anything about it!
~I do not feel well, everyone knows you feed a cold - or do you?
~I am depressed, I deserve a little treat!
~I already screwed up today with carbs so I'll get back on track tomorrow. Since I already blew it for the day I might as well go for it! Where's the cake?
Do any of these sound familiar? It really is true that the hardest part of weight loss surgery is not the surgery, it is the head stuff that goes along with it. For the first time in your life you are forced by sheer nature of the beast to confront your food demons. When you reach for that scrumptious food item and cannot eat enough to fix whatever is wrong, your issues are staring you in the face. I think it is normal to have a little denial at first and you ignore the food monster staring at you and you keep searching the kitchen looking for something that will fit in your stomach but... nothing is there. Frustration sets in and you swear you are hungry even though one more bite of food and you will be hugging your porcelain friend.
It is this crazy insane cycle that has to happen a few times before we begin to really "get" it. You notice a pattern that cannot be denied anymore. You feel stress, you eat. You feel sadness, you eat. You feel anger, you eat. You feel boredom, you eat. Patterns, but no real answers. Right?
There are a number of self help books out there, some great and some not so great. Everyone has their own take on the fix for our issues. I found a book I like and I will tell you why. It doesn't tell you of the horrors of eating food animals, it does not use aversion therapy, it does not give you one fad diet after another promising a forever cure to the disease of obesity. This one is not a diet, not a promise of a quick fix but instead more of a cognitive therapy approach. It is a set of daily exercises (mental and written, not physical) for six weeks. She writes what I call positive affirmations but she calls it a change in the way you are thinking. She's the PhD so she is probably correct! The book is:
"The Beck Diet Solution Weight Loss Workbook"
She has two books, one is a workbook and one is not. I suggest the non-workbook for pre ops and the workbook version for post ops. You honestly do not need both. Oh, you can buy both of them but I think you will find you are wasting your money.
In this book she has you change negative thinking to positive thinking but more important (at least to me) is you end up learning why you do what you do. You have written exercises, you have daily schedules to complete, food logs, columns to compare, and thinking to do. Not only do you face your demons you learn new coping methods. You learn to face your own behaviors and find alternative ways to cope. Really, a big part of this whole thing is being honest with yourself when you are eating for emotion instead of eating for nourishment. When you are eating because you found a way to justify it instead of when you are eating because your body needs fuel.
A big shocker for many is to understand a few key points here.
We can feel hungry, we can feel satisfied, and we can feel full. We are always looking for that full feeling. Thanksgiving Day full, feels so miserably good. Right? Did you know naturally thin people do not want to have that full feeling? They are very content with satisfied, or not hungry. It is us, our population that wants to be in misery we are so full. And in an hour we will do it again! How crazy are we? Well, we aren't crazy. We have a disease and that disease is called obesity.
A really good place to order this book is:
www.ADDall.com >> used and out of print books >> insert author name "Beck" >> insert title
This site is great because it combines ebay, Amazon, and 20,000 private sellers and this book is listed all the time by many sellers so you get to pick your price. As of this morning the book version was $1.41 USD and the workbook version was $6.00 USD. They have US sellers, Canadian sellers, and European sellers. Pick your country and pick your price. Although the books are listed as used most of them are actually new.
Another book people seem to like however I have not read it is:
"Good Calories, Bad Calories" by Gary Taubes.
Go to Amazon.com and read a few pages of each book and see what hits home for you.
Now, there is another reason some people eat the way we do and this is my own personal demon. OCD. Obsessive Compulsive Disorder. It is really the only area OCD seems to affect me, food. When I am stressed or frustrated I absolutely obsess over food. I think about it non stop and while I am eating I think about what I can eat when there is room in my banana sized stomach. I do not experience this all the time, just stages. I can go for weeks and it does not seem to kick in and all the sudden it is there full force. I look up recipes, I look at menus for various restaurants on line, I go to Recipekey.com where I can put ingredients I already have in my kitchen and it will give me recipes where I do not have to go to the store.
This is when I start taking Effexor. I am supposed to take it all the time and I do not. I take it for a couple of weeks here and there. This is what works for me. It kills my head hunger. My stomach rarely feels hungry due to the surgery type I have but my head goes through stages where it insists my stomach wants food.
I am very sure that I am not the only one out there that obsesses over food. I have talked to so many people that have the same issues and if it is indeed OCD, the medications can work quite well. If you feel this is your issue as well I suggest you talk to your doctor. Some are willing to let you try pharmaceuticals and some are not. Just find what is right for you and go for it!
Wednesday, March 17, 2010
Getting Real - Gross Stuff That Happens After WLS
Pre ops daydream wondering what it will be like to have a thin sexy body. They fantasize about cute clothes, the opposite sex (or same) doing a double take. They cannot possibly wait for the day they can dress up, look good, walk proudly, and everyone will gasp at the changes. The idea of going shopping and buying tiny little clothes that fit makes women dream before they even go to sleep at night! You know, these are all good and reasonable expectations - to a point. But you have to know there is a bit of a price to pay to get there. The upside to this is that with a little effort they are all doable and you can fix them! If you know about it beforehand you are ready to prevent problems and issues.
Burping-
This is common in all surgery types for up to a couple of months post op. It is merely esophageal irritation and it will go away in no time! It can also be from swallowing too much air. It takes time and practice to learn to stop the behavior. It was never a big deal before when you had a normal size stomach. Today you are using a small portion of your original stomach and a small amount of air goes a long way.
Constipation-
I think most experience it post op regardless of surgery type. Sometimes on the liquid stage of the post op diet there is diarrhea (liquids in/liquids out). But after that it is constipation. It happens for a variety of reasons. High protein/low fiber diet, not enough liquids, drastic change in diet, pain meds, lots of reasons. Also, keep in mind that before this whole journey started you were eating a lot more food than you are now. You aren't supposed to pooh as much today as you did a few months ago.
It is my experience from reading the boards that while all surgery types can experience this banded folks and bypass folks seem to experience this the most. As a previously banded person I can tell you that it was a serious challenge to eat fibrous foods such as broccoli. Bands and bypass have a stoma and many times it is hard to eat veggies with a stoma until a 6-12 months post op. Not always, but sometimes. Also, with an itty bitty stomach it is more of a challenge to get needed fluids in and we tend to get lazy and simply not drink as we should.
The very best cure for constipation is prevention. Seriously, do what you need to so you do not end up with a problem that leads you to an Emergency Room with an old guy wearing thick glasses lubing up a gloved hand and going on a digging expedition. You will not enjoy it and neither will he.
Most tend to reach for a laxative and that is not always a great option. That is something you might have to resort to but it is not something you want to do on a regular basis, just in a pinch.
There is Metamucil and I do NOT suggest newbie post ops, bands, or bypass use this product. It can set like a firm gel and be very painful in your stomach.
Benefiber is good stuff, easy to take, and no taste. You can actually mix this product with water and after it dissolves you cannot taste it. The down side to this product is that it can take a good month to work if taken on a regular basis.
Miralax is a great product and no longer by prescription only. You can buy it at any decent size drug store. It is a powder that you mix with a sugar free drink. You can take it as a preventative measure or to fix an already existing problem.
Colace (The generic is fine, Docusate Sodium) and this is a stool softener. It will not fix an existing problem but it will prevent you from getting constipated to begin with.
Then the usuals, prune juice, baby food stewed prunes, apple juice for some, and other assorted fruit juices that seem to get people going. Plum juice is reported by many to do well.
Monkey Breath-
While constipation bothers you a great deal more than those around you, bad breath bothers those around you more than it does you.
Usually this is from ketosis. When you start cutting carbs and burning fat the burned fat changes to various chemicals and those chemicals are released through body fluids such as urine, saliva, tears, and one other - when you exhale. So your breath is going to be bad. You can brush your teeth until you brush the enamel off your teeth, your breath is still not going to smell minty fresh. It will smell like minty monkey breath. The solution is sugar free mints, sugar free drops that are breath fresheners, and just anything you can grab in a hurry if you are in an enclosed space with someone such as a small office, car, etc.
Body Odor-
This does not happen to everyone but it does happen to many. Remember, there are lots of toxins and such stored in fat cells and as you burn the fat sometimes you smell bad. It has nothing to do with obesity, it would happen if a thinner person burned fat as well. The solution is simple, shower daily.
Also, sometimes as people lose weight they end up with more skin folds. Lots of nice warm dark places for fungus to grow. An antibacterial soap is not going to help but it might hurt. An antibacterial cannot kill a fungus. You need an anti-fungal. Jock itch spray, athletes foot spray - these products can fix an existing problem.
Nausea-
You just had major surgery. Your stomach is not happy, some people get nausea and it is usually is temporary. Your doctor can prescribe anti-emetics (stops nausea) or you can try some home remedies. Coke syrup can be purchased at Walgreens or any large drug store. (Bypass patients could dump on this.) Another good one is licorice tablets found at health food stores. Usually one dose before each meal does the trick.
Smelly Gas-
This is more of a problem for people with malabsorption such as Gastric Bypass and DS. Due to the rearrangement of intestines the body is unable to do the job as intended at birth. Sometimes there is an overgrowth of bacteria in the GI system and this can create gas, smelly gas. Usually probiotics prevent the problem and Flagyl (a prescription antibiotic) fixes an existing problem.
This problem seems to be worse after eating refined processed white carbs.
Female cycles-
Many women complain of changes in their cycles. Female hormones are stored in fat cells and as we burn fat hormones are released. This can play havoc on your cycles. Some women have harder more painful cycles until their weight evens out a bit and some have fewer cycles.
Sadly there are not a lot of fixes for this. If you take additional hormones you are risking blood clots and strokes due to obesity. This is something that if problematic, talk to your GYN.
For those with PCOS you might find that after surgery you start having cycles again or if you have cycles just not often you might become more regular after losing even 30#.
Do note: After losing massive amounts of weight you are very likely to be far more fertile and this includes PCOS women as well as non-PCOS women. If you want a child then please wait for a year or so after getting to goal before getting pregnant. Your body needs to heal from massive weight loss before you can safely carry a baby. This is for your safety as well as the baby.
Excess skin-
This is a much discussed topic on any weight loss surgery board and there are so many myths and misinformation posted.
It is NOT true that slow weight loss means less excess skin.
It is NOT true that exercise will prevent excess skin, while it may fill out a small bit of skin with firm muscle, it will not affect excess skin.
It is NOT true that moisturizers prevent excess skin. While it may improve the overall appearance of your skin, it does not prevent excess skin.
It is NOT true that you can have plastic surgery done for a discounted price in trade for donating excess skin. Burn units cannot use our skin, it has no elasticity anymore, it is not healthy skin and burn patients cannot use it.
Skin is skin just like any other organ in your body and once it is damaged it does not usually go back to pre-obesity days. It depends on several factors such as genetics, amount of excess weight and similar issues.
You will not know for sure one way or another if you will have this problem. If you do you can buy binders and special clothing to smooth things out a bit or you can have plastic surgery. Never forget, as you will see on various boards time and time again, you can hide excess skin. You cannot hide excess fat. Just worry about getting healthy, deal with skin issues when you get to goal.
As you can see none of these issues are things we cannot overcome. Just know about them beforehand so you can deal with them if they happen. I swear to you, all the above is nothing in the whole scheme of things once you hit goal.
Burping-
This is common in all surgery types for up to a couple of months post op. It is merely esophageal irritation and it will go away in no time! It can also be from swallowing too much air. It takes time and practice to learn to stop the behavior. It was never a big deal before when you had a normal size stomach. Today you are using a small portion of your original stomach and a small amount of air goes a long way.
Constipation-
I think most experience it post op regardless of surgery type. Sometimes on the liquid stage of the post op diet there is diarrhea (liquids in/liquids out). But after that it is constipation. It happens for a variety of reasons. High protein/low fiber diet, not enough liquids, drastic change in diet, pain meds, lots of reasons. Also, keep in mind that before this whole journey started you were eating a lot more food than you are now. You aren't supposed to pooh as much today as you did a few months ago.
It is my experience from reading the boards that while all surgery types can experience this banded folks and bypass folks seem to experience this the most. As a previously banded person I can tell you that it was a serious challenge to eat fibrous foods such as broccoli. Bands and bypass have a stoma and many times it is hard to eat veggies with a stoma until a 6-12 months post op. Not always, but sometimes. Also, with an itty bitty stomach it is more of a challenge to get needed fluids in and we tend to get lazy and simply not drink as we should.
The very best cure for constipation is prevention. Seriously, do what you need to so you do not end up with a problem that leads you to an Emergency Room with an old guy wearing thick glasses lubing up a gloved hand and going on a digging expedition. You will not enjoy it and neither will he.
Most tend to reach for a laxative and that is not always a great option. That is something you might have to resort to but it is not something you want to do on a regular basis, just in a pinch.
There is Metamucil and I do NOT suggest newbie post ops, bands, or bypass use this product. It can set like a firm gel and be very painful in your stomach.
Benefiber is good stuff, easy to take, and no taste. You can actually mix this product with water and after it dissolves you cannot taste it. The down side to this product is that it can take a good month to work if taken on a regular basis.
Miralax is a great product and no longer by prescription only. You can buy it at any decent size drug store. It is a powder that you mix with a sugar free drink. You can take it as a preventative measure or to fix an already existing problem.
Colace (The generic is fine, Docusate Sodium) and this is a stool softener. It will not fix an existing problem but it will prevent you from getting constipated to begin with.
Then the usuals, prune juice, baby food stewed prunes, apple juice for some, and other assorted fruit juices that seem to get people going. Plum juice is reported by many to do well.
Monkey Breath-
While constipation bothers you a great deal more than those around you, bad breath bothers those around you more than it does you.
Usually this is from ketosis. When you start cutting carbs and burning fat the burned fat changes to various chemicals and those chemicals are released through body fluids such as urine, saliva, tears, and one other - when you exhale. So your breath is going to be bad. You can brush your teeth until you brush the enamel off your teeth, your breath is still not going to smell minty fresh. It will smell like minty monkey breath. The solution is sugar free mints, sugar free drops that are breath fresheners, and just anything you can grab in a hurry if you are in an enclosed space with someone such as a small office, car, etc.
Body Odor-
This does not happen to everyone but it does happen to many. Remember, there are lots of toxins and such stored in fat cells and as you burn the fat sometimes you smell bad. It has nothing to do with obesity, it would happen if a thinner person burned fat as well. The solution is simple, shower daily.
Also, sometimes as people lose weight they end up with more skin folds. Lots of nice warm dark places for fungus to grow. An antibacterial soap is not going to help but it might hurt. An antibacterial cannot kill a fungus. You need an anti-fungal. Jock itch spray, athletes foot spray - these products can fix an existing problem.
Nausea-
You just had major surgery. Your stomach is not happy, some people get nausea and it is usually is temporary. Your doctor can prescribe anti-emetics (stops nausea) or you can try some home remedies. Coke syrup can be purchased at Walgreens or any large drug store. (Bypass patients could dump on this.) Another good one is licorice tablets found at health food stores. Usually one dose before each meal does the trick.
Smelly Gas-
This is more of a problem for people with malabsorption such as Gastric Bypass and DS. Due to the rearrangement of intestines the body is unable to do the job as intended at birth. Sometimes there is an overgrowth of bacteria in the GI system and this can create gas, smelly gas. Usually probiotics prevent the problem and Flagyl (a prescription antibiotic) fixes an existing problem.
This problem seems to be worse after eating refined processed white carbs.
Female cycles-
Many women complain of changes in their cycles. Female hormones are stored in fat cells and as we burn fat hormones are released. This can play havoc on your cycles. Some women have harder more painful cycles until their weight evens out a bit and some have fewer cycles.
Sadly there are not a lot of fixes for this. If you take additional hormones you are risking blood clots and strokes due to obesity. This is something that if problematic, talk to your GYN.
For those with PCOS you might find that after surgery you start having cycles again or if you have cycles just not often you might become more regular after losing even 30#.
Do note: After losing massive amounts of weight you are very likely to be far more fertile and this includes PCOS women as well as non-PCOS women. If you want a child then please wait for a year or so after getting to goal before getting pregnant. Your body needs to heal from massive weight loss before you can safely carry a baby. This is for your safety as well as the baby.
Excess skin-
This is a much discussed topic on any weight loss surgery board and there are so many myths and misinformation posted.
It is NOT true that slow weight loss means less excess skin.
It is NOT true that exercise will prevent excess skin, while it may fill out a small bit of skin with firm muscle, it will not affect excess skin.
It is NOT true that moisturizers prevent excess skin. While it may improve the overall appearance of your skin, it does not prevent excess skin.
It is NOT true that you can have plastic surgery done for a discounted price in trade for donating excess skin. Burn units cannot use our skin, it has no elasticity anymore, it is not healthy skin and burn patients cannot use it.
Skin is skin just like any other organ in your body and once it is damaged it does not usually go back to pre-obesity days. It depends on several factors such as genetics, amount of excess weight and similar issues.
You will not know for sure one way or another if you will have this problem. If you do you can buy binders and special clothing to smooth things out a bit or you can have plastic surgery. Never forget, as you will see on various boards time and time again, you can hide excess skin. You cannot hide excess fat. Just worry about getting healthy, deal with skin issues when you get to goal.
As you can see none of these issues are things we cannot overcome. Just know about them beforehand so you can deal with them if they happen. I swear to you, all the above is nothing in the whole scheme of things once you hit goal.
Monday, March 15, 2010
Eating Clean - Slowly Changing Food Habits
Have you ever heard the term, "Eating Clean?" It is basically all about getting down to basics. Instead of buying canned beans, make your own! It is *so* easy, cheaper, healthier, and you control the fat, sodium, and best of all - lard! Instead of eating processed foods such as fast food, Hamburger Helper, Tuna Helper, canned soups, canned foods in general it is all about getting down to basics.
This is a great thing to start before you ever have surgery. The trick to eating clean is not to decide tomorrow you are going to do it, that is all wrong! That is where we fail. The key is gradually introducing good foods to your diet. Do not take away everything all at once, you will be left feeling deprived, depressed, and you will be unlikely to do well. Instead of taking away, ADD foods!
What is your diet like? Fast foods and processed foods? That is probably what you eat if you are like a majority of people today. Do you want McDonald's? Fine, eat it... for now. ;o) But add something healthy to it in the meantime. Daily add a new food. Alternate between fruits and vegetables. What veggies do you like? Do you like broccoli? Fine! Today add 1/4 cup of broccoli to your diet. Eat what you will, but eat the broccoli first. Tomorrow, add a fruit. Do you like bananas? Great, tomorrow add 1/4 cup of broccoli and a small banana and eat as you usually do. But eat the fruits and veggies first, the the McDonald's.
What about the day after tomorrow? Add another veggie. Do you like carrots? Great! Add 1/4 cup of fresh carrots. So before your main meal you'll add 1/4 cup broccoli, 1 small banana, and 1/4 cup of fresh carrots. The day after add another fruit. Daily just add a new fruit or veggie. Do not, I repeat do NOT take away foods at this point. Do not deny yourself McDonald's, but do eat the fruits and veggies first before your main meal.
As the quantity of food increases daily start spreading the fruits and veggies out throughout the day before meals. Soon you simply will not be able to eat in quantity anymore, you will be unable to eat all the fresh fruits and veggies as well as the processed and fast foods.
When we diet we are taking foods away. That does not work, right? So add foods. Supposedly some brilliant person somewhere claimed that it takes three weeks to learn new habits. I do not know, maybe that is true, maybe not. But I can tell you that new habits do happen with time. Before you know it you really end up craving that fresh salad made your way vs. the processed foods you had been eating. This does not happen overnight and that is okay. Our bad habits did not happen over night either.
Go to the grocery store. Do not bring your spouse or your kids, they will annoy you. Go by yourself when you have a good hour to roam the produce section. Look at the colors of the produce. Yellow squash, green broccoli, red bell peppers, purple cabbage, orange oranges, yellow bananas, shop by color. Seriously stop and look at all the produce, find something you have never tried before and buy one. Take it home and experiment with it, look up various recipes, find something that sounds good. Better yet while you are in the grocery store find someone with a huge cart full of all produce and be bold, walk up to them with a produce item you have no clue how to prepare and ask them. Do what I do, find any sweet little old lady and ask her how she prepares whatever item you are holding. I have yet to have a little old lady that did not give me a cooking lesson if I asked for a bit of education. And let's face it, little old ladies are usually GREAT cooks!
Try one new produce item every week. Some will be winners and some will be gross. That's okay! You tried it but the point is, you will find items you do like in the meantime.
SALADS-
Make great salads! The key to a great salad is that you put items in there that you like. Make it your salad! And do not forget, not all salads have to contain lettuce. My favorite salad (I will post the recipe with dressing in full later in the blog under recipes) has no lettuce. It has:
Black beans
Corn
Celery
Onions
Serrano
Red bell pepper
Green bell pepper
Pineapple
Add items you like and take away what you do not like. Want more heat? Add jalapeno peppers instead. Maybe your surgery type does not work well with stringy pineapple so add diced apple instead. The key to a good salad is only put ingredients in there that you like and add lots of tastes and textures. Soft beans, crunchy bell peppers, sweet pineapple, flavorful onions. It is a burst of flavors and textures with each bite. It keeps your mouth and mind interested.
Do you like lettuce salads but your WLS stomach disagrees with your mind? Try salad with no lettuce. All the veggies you would usually put on a salad put in a bowl. Something like:
Tomatoes chopped
Celery diced
Onions diced
Radishes diced
Yellow squash diced
Zucchini diced
English Cucumber diced
Whatever veggies you would usually put on top of salads just cut them up, put them in a bowl, marinate in Italian dressing for a few hours and enjoy.
Try new salad dressings and do not be conventional. Be creative and try new foods! You might just like them!! A staple around my house is the following:
PICO DE GALLO
Roma tomatoes, quartered, remove seeds, chop fine 2 medium
Tomatillo 1 medium chopped fine
1/2 Red or Yellow onion, diced
1 Serrano (for more heat use jalapeno pepper instead)
Cilantro to taste
Salt to taste
Lime juice 1 tbsp
With the lime juice it will keep well for 4 days. Use that as a salad dressing, put on top of chili, make tostadas, refried beans, cheese, Pico de Gallo.
Try new flavors of salad dressings. Sweet, sour, tart, whatever your pleasure. My favorite store dressing is made by Girards, it is in the salad dressing aisle, in a glass triangular bottle and it is Chinese Chicken Salad.
Diced chicken
Romaine lettuce
Those tiny baby corn on the cobs (sorry, I do not know the proper name)
Water chestnuts
Crunchy Chinese noodles
Girards Dressing
Try Extra Virgin Olive Oil based dressings, the oil is good for you, for those with bands or bypass and you have a stoma it does help to lube the food through your stoma, it is the right kind of fat, and it tastes good. Dressings do not end with Mayo alone.
The key to a good salad again, making it your way, lots of colors, lots of textures, and lots of flavors. Think of salads as you would your family recipe for chili or spaghetti sauce. There are as many recipes as there are people cooking. Make it your way, that is all that matters.
BEANS-
Instead of buying canned beans make your own. It is so much better and after you make your own beans - canned just will not do the trick anymore.
A general rule of thumb:
Soak dry beans in water for 8 hours or overnight,
Never salt beans until after they are cooked or they will be tough,
Use your crock pot/slow cooker because it is easier,
Use Crock Pot/Slow Cooker liners so you do not have a huge mess to clean later.
That is it. Soak your pinto beans, black beans, lentils, whatever your pleasure throughout the night, using a crock pot liner use the entire bag of beans with more water, chicken stock, vegetable stock, whatever you have around. Add chili powder, onions, and garlic. Let the beans cook all day. Use what you want for a recipe and put the rest in the freezer for next time. They freeze well and you always have fresh beans for a recipe.
Make your own refried beans, it is far easier than you may realize. Just cook your favorite beans as outlined above, reserve a small amount of the water they were cooked in, add a bit of EVOO, more chili powder, garlic, salt, pepper, and smash. That's it, you do not need to fry them unless you want to. My favorite is refried black beans. The texture is much more smooth than pinto beans.
Add beans to lettuce salads, soups, chili, make bean salads, the list is endless.
Quiche (From Ana O'Donnell:
In muffin cups, mix:
2 cloves minced garlic
2 cups chopped broccoli
1 tbsp olive oil
1/3 cup 2% milk
7 eggs
1 cup shredded mozz (used whole milk b/c that's all I had on hand)
A bit of Mozz cheese
Mix, stir, whatever. Pour into muffin cups line with either liners or EVOO and bake at 350(F) for 12 minutes. She said they are 90 calories each and you have good protein, good fiber, and good food!
When you go grocery shopping, shop outside the aisles. Produce, meat, dairy... those are the sections you should buy most of your items. The aisles are where you'll find the overly processed foods. Canned meats, canned veggies, canned fruits, canned dinners, canned pasta, all the foods that got us fat to begin with are there. Shop the perimeters of the grocery store, that is where the best foods are.
Again, please do not try to make fast and drastic changes to your diet, it does not work. Do not take away from your diet just yet, add to it instead. Try new foods every week when you go to the store. Shop the produce aisle by color and buy lots of colors and try one new item weekly. Make your food fun and interesting by adding lots of textures, colors, and flavors. Make food the way you like it.
WATER-
Water is essential for health and clean eating. It is probably more important during the weight loss stage and there is a reason for this. When you burn fat that fat is turned into chemicals that your body gets rid of via bodily fluids and when you exhale. Mostly it is in urine but it is in saliva as well. It is critical to flush out these chemicals as you burn fat.
Nothing really replaces water. Juice does not replace water, it does make your pancreas work to pump out insulin due to the blood sugar spikes. Same with milk. Tea typically has caffeine and that makes your heart work harder. Sugar free drinks still have chemicals and sweeteners. Nothing beats plain old water. If you can get it down plain, that is best. If you just are not a water drinker then please, at least get sugar free, caffeine free liquids down daily.
PROTEIN-
Protein has multiple functions:
1. build and repair body tissue.
2. maintain cell growth in the formation of new body tissue. This is especially important if the body is growing rapidly, injured, or under stress.
3. aid in the formation of enzymes, some hormones and antibodies.
4. provide as energy if sufficient carbohydrates and fats are not supplied by the diet.
A protein is basically a full chain of 23 amino acids. If not all amino acids are present then it is not a full protein chain. Foods that are complete protein chains are foods such as beef, chicken, duck, goose, pork, fish, seafood, elk, and bison as well as most dairy, brewers yeast, most nuts, etc. Foods that are a partial protein chain are most beans such as black beans, pinto beans, (It should be noted that lentils are a full protein chain.) grains, and peas. Protein must be consumed daily. While you can go for several days without protein especially immediately post op, you should do your best to consume protein as soon as possible.
Protein will also help boost metabolism if in a lean version such as lean meats.
"Proteins are needed at all meals but especially at breakfast to replenish amino acids used for growth and maintenance during the night. Excess protein not immediately needed by the body is converted to fat and stored in adipose tissues to be used as energy. Unfortunately it cannot be converted back to amino acids." (source is: http://www.uen.org/Lessonplan/preview.cgi?LPid=1269, I cite this source since it is a controversial topic of when and how to consume protein.)
A healthy diet is essential to weight loss. Massive weight loss is a huge insult to the human body, we can overcome potential future problems by a quality diet of unprocessed foods. Getting to basics is essential to health and simply feeling good.
Enjoy your food!
This is a great thing to start before you ever have surgery. The trick to eating clean is not to decide tomorrow you are going to do it, that is all wrong! That is where we fail. The key is gradually introducing good foods to your diet. Do not take away everything all at once, you will be left feeling deprived, depressed, and you will be unlikely to do well. Instead of taking away, ADD foods!
What is your diet like? Fast foods and processed foods? That is probably what you eat if you are like a majority of people today. Do you want McDonald's? Fine, eat it... for now. ;o) But add something healthy to it in the meantime. Daily add a new food. Alternate between fruits and vegetables. What veggies do you like? Do you like broccoli? Fine! Today add 1/4 cup of broccoli to your diet. Eat what you will, but eat the broccoli first. Tomorrow, add a fruit. Do you like bananas? Great, tomorrow add 1/4 cup of broccoli and a small banana and eat as you usually do. But eat the fruits and veggies first, the the McDonald's.
What about the day after tomorrow? Add another veggie. Do you like carrots? Great! Add 1/4 cup of fresh carrots. So before your main meal you'll add 1/4 cup broccoli, 1 small banana, and 1/4 cup of fresh carrots. The day after add another fruit. Daily just add a new fruit or veggie. Do not, I repeat do NOT take away foods at this point. Do not deny yourself McDonald's, but do eat the fruits and veggies first before your main meal.
As the quantity of food increases daily start spreading the fruits and veggies out throughout the day before meals. Soon you simply will not be able to eat in quantity anymore, you will be unable to eat all the fresh fruits and veggies as well as the processed and fast foods.
When we diet we are taking foods away. That does not work, right? So add foods. Supposedly some brilliant person somewhere claimed that it takes three weeks to learn new habits. I do not know, maybe that is true, maybe not. But I can tell you that new habits do happen with time. Before you know it you really end up craving that fresh salad made your way vs. the processed foods you had been eating. This does not happen overnight and that is okay. Our bad habits did not happen over night either.
Go to the grocery store. Do not bring your spouse or your kids, they will annoy you. Go by yourself when you have a good hour to roam the produce section. Look at the colors of the produce. Yellow squash, green broccoli, red bell peppers, purple cabbage, orange oranges, yellow bananas, shop by color. Seriously stop and look at all the produce, find something you have never tried before and buy one. Take it home and experiment with it, look up various recipes, find something that sounds good. Better yet while you are in the grocery store find someone with a huge cart full of all produce and be bold, walk up to them with a produce item you have no clue how to prepare and ask them. Do what I do, find any sweet little old lady and ask her how she prepares whatever item you are holding. I have yet to have a little old lady that did not give me a cooking lesson if I asked for a bit of education. And let's face it, little old ladies are usually GREAT cooks!
Try one new produce item every week. Some will be winners and some will be gross. That's okay! You tried it but the point is, you will find items you do like in the meantime.
SALADS-
Make great salads! The key to a great salad is that you put items in there that you like. Make it your salad! And do not forget, not all salads have to contain lettuce. My favorite salad (I will post the recipe with dressing in full later in the blog under recipes) has no lettuce. It has:
Black beans
Corn
Celery
Onions
Serrano
Red bell pepper
Green bell pepper
Pineapple
Add items you like and take away what you do not like. Want more heat? Add jalapeno peppers instead. Maybe your surgery type does not work well with stringy pineapple so add diced apple instead. The key to a good salad is only put ingredients in there that you like and add lots of tastes and textures. Soft beans, crunchy bell peppers, sweet pineapple, flavorful onions. It is a burst of flavors and textures with each bite. It keeps your mouth and mind interested.
Do you like lettuce salads but your WLS stomach disagrees with your mind? Try salad with no lettuce. All the veggies you would usually put on a salad put in a bowl. Something like:
Tomatoes chopped
Celery diced
Onions diced
Radishes diced
Yellow squash diced
Zucchini diced
English Cucumber diced
Whatever veggies you would usually put on top of salads just cut them up, put them in a bowl, marinate in Italian dressing for a few hours and enjoy.
Try new salad dressings and do not be conventional. Be creative and try new foods! You might just like them!! A staple around my house is the following:
PICO DE GALLO
Roma tomatoes, quartered, remove seeds, chop fine 2 medium
Tomatillo 1 medium chopped fine
1/2 Red or Yellow onion, diced
1 Serrano (for more heat use jalapeno pepper instead)
Cilantro to taste
Salt to taste
Lime juice 1 tbsp
With the lime juice it will keep well for 4 days. Use that as a salad dressing, put on top of chili, make tostadas, refried beans, cheese, Pico de Gallo.
Try new flavors of salad dressings. Sweet, sour, tart, whatever your pleasure. My favorite store dressing is made by Girards, it is in the salad dressing aisle, in a glass triangular bottle and it is Chinese Chicken Salad.
Diced chicken
Romaine lettuce
Those tiny baby corn on the cobs (sorry, I do not know the proper name)
Water chestnuts
Crunchy Chinese noodles
Girards Dressing
Try Extra Virgin Olive Oil based dressings, the oil is good for you, for those with bands or bypass and you have a stoma it does help to lube the food through your stoma, it is the right kind of fat, and it tastes good. Dressings do not end with Mayo alone.
The key to a good salad again, making it your way, lots of colors, lots of textures, and lots of flavors. Think of salads as you would your family recipe for chili or spaghetti sauce. There are as many recipes as there are people cooking. Make it your way, that is all that matters.
BEANS-
Instead of buying canned beans make your own. It is so much better and after you make your own beans - canned just will not do the trick anymore.
A general rule of thumb:
Soak dry beans in water for 8 hours or overnight,
Never salt beans until after they are cooked or they will be tough,
Use your crock pot/slow cooker because it is easier,
Use Crock Pot/Slow Cooker liners so you do not have a huge mess to clean later.
That is it. Soak your pinto beans, black beans, lentils, whatever your pleasure throughout the night, using a crock pot liner use the entire bag of beans with more water, chicken stock, vegetable stock, whatever you have around. Add chili powder, onions, and garlic. Let the beans cook all day. Use what you want for a recipe and put the rest in the freezer for next time. They freeze well and you always have fresh beans for a recipe.
Make your own refried beans, it is far easier than you may realize. Just cook your favorite beans as outlined above, reserve a small amount of the water they were cooked in, add a bit of EVOO, more chili powder, garlic, salt, pepper, and smash. That's it, you do not need to fry them unless you want to. My favorite is refried black beans. The texture is much more smooth than pinto beans.
Add beans to lettuce salads, soups, chili, make bean salads, the list is endless.
Quiche (From Ana O'Donnell:
In muffin cups, mix:
2 cloves minced garlic
2 cups chopped broccoli
1 tbsp olive oil
1/3 cup 2% milk
7 eggs
1 cup shredded mozz (used whole milk b/c that's all I had on hand)
A bit of Mozz cheese
Mix, stir, whatever. Pour into muffin cups line with either liners or EVOO and bake at 350(F) for 12 minutes. She said they are 90 calories each and you have good protein, good fiber, and good food!
When you go grocery shopping, shop outside the aisles. Produce, meat, dairy... those are the sections you should buy most of your items. The aisles are where you'll find the overly processed foods. Canned meats, canned veggies, canned fruits, canned dinners, canned pasta, all the foods that got us fat to begin with are there. Shop the perimeters of the grocery store, that is where the best foods are.
Again, please do not try to make fast and drastic changes to your diet, it does not work. Do not take away from your diet just yet, add to it instead. Try new foods every week when you go to the store. Shop the produce aisle by color and buy lots of colors and try one new item weekly. Make your food fun and interesting by adding lots of textures, colors, and flavors. Make food the way you like it.
WATER-
Water is essential for health and clean eating. It is probably more important during the weight loss stage and there is a reason for this. When you burn fat that fat is turned into chemicals that your body gets rid of via bodily fluids and when you exhale. Mostly it is in urine but it is in saliva as well. It is critical to flush out these chemicals as you burn fat.
Nothing really replaces water. Juice does not replace water, it does make your pancreas work to pump out insulin due to the blood sugar spikes. Same with milk. Tea typically has caffeine and that makes your heart work harder. Sugar free drinks still have chemicals and sweeteners. Nothing beats plain old water. If you can get it down plain, that is best. If you just are not a water drinker then please, at least get sugar free, caffeine free liquids down daily.
PROTEIN-
Protein has multiple functions:
1. build and repair body tissue.
2. maintain cell growth in the formation of new body tissue. This is especially important if the body is growing rapidly, injured, or under stress.
3. aid in the formation of enzymes, some hormones and antibodies.
4. provide as energy if sufficient carbohydrates and fats are not supplied by the diet.
A protein is basically a full chain of 23 amino acids. If not all amino acids are present then it is not a full protein chain. Foods that are complete protein chains are foods such as beef, chicken, duck, goose, pork, fish, seafood, elk, and bison as well as most dairy, brewers yeast, most nuts, etc. Foods that are a partial protein chain are most beans such as black beans, pinto beans, (It should be noted that lentils are a full protein chain.) grains, and peas. Protein must be consumed daily. While you can go for several days without protein especially immediately post op, you should do your best to consume protein as soon as possible.
Protein will also help boost metabolism if in a lean version such as lean meats.
"Proteins are needed at all meals but especially at breakfast to replenish amino acids used for growth and maintenance during the night. Excess protein not immediately needed by the body is converted to fat and stored in adipose tissues to be used as energy. Unfortunately it cannot be converted back to amino acids." (source is: http://www.uen.org/Lessonplan/preview.cgi?LPid=1269, I cite this source since it is a controversial topic of when and how to consume protein.)
A healthy diet is essential to weight loss. Massive weight loss is a huge insult to the human body, we can overcome potential future problems by a quality diet of unprocessed foods. Getting to basics is essential to health and simply feeling good.
Enjoy your food!
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