Kristopia

Why am I leaving the US for Surgery? Here are my reasons: 1. My United Health Care insurance refuses to pay for ANY type of WLS surgery - they won't even pay for a doctor supervised weight loss program, period. Ridiculous. 2. I live in "medicine city" - Durham, NC. We have Duke Medical Center, not to mention huge amounts of other hospitals, specialists, pharmaceutical companies, labs, etc. Even so, I found two surgeons that were even slightly experienced in VSG - I was going to get RNY (because to me, a tool is a tool, except I didn't want a lapband, for all the reasons cited on this board), because insurance would never cover VSG - not this insurance in this state. 3. I saw my surgeon twice - once back in January at the seminar, and once at an initial consultation for 10 minutes. He was nice - but damn, 10 minutes? His office staff were coldly polite, and the insurance girl was a pain in the butt - she never called me back when she said she would, and she told my my insurance would cover - I jumped through ALL the hoops, and got ALL the pre-surgical testing. All of it. I have spent well over $1000 out of pocket for all of the pre-surgical testing. More to come, I'm sure, as I'm not done getting all the bills yet that insurance wants me to copay, etc. In the end, nothing. 4. My surgeon, while experienced with RNY and lapband, has only done about 30 VSG surgeries. And even with RNY and lapband, he doesn't measure up to the experience my chosen Mexican surgeon has....OR his track record. 5. In the US, my surgery would cost a total of $35,000, including surgeon's fees and hospital fees (that's only two nights in hospital) if I pay out of pocket. Seriously?? Yep, seriously. So, I researched surgeons in Mexico, and researched, and researched, and I've chosen my surgeon. I've chosen Dr. Armando Joya in Puerto Vallarta, Mexico. I know Dr. Asceves seems to be the popular choice here, and I'm certain he's a great surgeon (they were both tied until recently), but here are the reasons I have chosen Dr. Joya for myself (and we all must make a personal choice of surgeon we are most comfortable with). 1. Dr. Joya has well over 500 VSG surgeries under his belt, as well as thousands of other surgeries including metabolic, etc. He is a gastroenterologist, which I'm glad about. He seems to me to run pretty much even with Dr. Aceves. So it came down to cost and location, really. 2. Covered in that cost is three nights in the resort, two nights in hospital, cabs, yadda yadda yadda. Everything but flight - and complication insurance. It's a little higher than Aceves, but I'm willing to pay the extra for my comfort level. 3. Private small lovely hospital. 4. Flight goes straight in to Puerto Vallarta airport, where you are met with a sign with your name on it, then transported to the resort, which is only 10 minutes away from the airport. You are met by Natalie, Dr. Joya's coordinator/assistant. The hospital is from 5 to 10 minutes from the hotel. All of the transport is taken care of (though I'll carry money for tips for the drivers). 5. After surgery, like Dr. Aceves, there are leak tests performed. 6. I will not have any drives over borders or for longer periods after surgery - I'll have the very short drive to the Puerto Vallarta airport, and then a 20 minute trip from my airport here in NC to my apartment. The flight itself, with one stop in either Dallas or Houston, is in two sections, both under 2 1/2 hours. The layover is short, so enough time to walk a bit in the stopover spot, but not enough time to be uncomfortable or overtired. 7. the location. I have always gone to the ocean to heal, whether it be emotional healing or physical. there is just something about Water that I need. And, a very close friend is going with me - we decided also that since both doctors were equal in my estimation, it was worth a little extra to go to Puerto Vallarta, which is beautiful. I'll spend two days extra vacationing (except for food, I'll be stuck with clear juices and broths and water) before surgery, and a couple extra after I leave the hospital as well. 8. Dr. Joya actually comes to visit his patients in the resort. Can't get that in the United States :thumbup: I seriously doubt the surgeon here would make house calls. I believe I have made the best choice for me and my comfort level. Several docs in Mexico are highly reputable, but Dr. Joya is my choice for the reasons above and many others, but this e-mail is too long already I'm going to send my deposit within the next few days (either tomorrow or Monday), and hopefully will get my passport soon so I can schedule the surgery for end of July or early August.

Hi Wasa - thanks for your PM clarification and for giving me the links to the threads. I appreciate them very much. I don't see where they make Dr. Joya look unethical, though definitely things could have been handled better regarding the nicked liver situation. Her issue wasn't that her liver was nicked (it was enlarged and that can happen) - it was that Natalie didn't tell her until she was preparing to walk out of the hospital that she had to pay the $1200 additional before she could leave. Not a very good administrative decision, and it was stress for her that she didn't need. The hospital should have told her husband immediately while she was in recovery about the additional charges, so he could take care of it before her discharge, and avoided the extra stress. As to the man with the leak - again, very sad situation, but also happens, especially in older patients who have other issues, and I don't see where Dr. Joya was unethical there, either. In fact, the poster actually complimented the Doctor that he tried his best to get rid of all the costs he could, but that he could not get rid of the hospital charges themselves for four extra weeks in the hospital. He stated that Dr. Joya, Natalie, and the hospital staff were all very kind and professional with him in the extra time he had to spend in PV. He said he ended up paying double what he had paid for the initial surgery - that is $10,500 more - for FOUR EXTRA WEEKS in a hospital. My guess is they discounted him pretty heavily to get it down to that. Thing is, these things do happen - anywhere. They happen often in the U.S. Though I'm sure it was scary to have to stay an extra month in a foreign country for surgical complications, that is a chance we take when leaving the country for surgery. The woman who talked to Dr. Joya and he mentioned the RNY said this: Thanks all! I didn't feel he tried to convince me (he was recommending) and didn't feel trapped at all! Also I didn't feel it was money-related. I think he is very skilled with both RNY and sleeve. He is straight-forward and expressed his point of view in my case once I explained my feelings and concerns. At the end of the day, the told me it was MY choice, that it was a big commitment and that I had to go with what I am comfortable with. He seemed so at ease in his recommendation of the bypass for me that I had to question myself....but at the end of the day, I feel I have to stick to what I really wanted, the sleeve (thanks MWG) And thanks to you all, you are a great board!! Again, in this situation, the person said she did not at all feel pressured into getting the RNY, but that he was giving her options. To me, that is just what a surgeon should do - provide options and allow the patient to make the best decision to fit their needs and/or fears. At the end of the day, while these situations were unfortunate, I don't see any unethical practices. I see a really crappy situation where they should have told a client earlier so that she owed more money. In the long term, from what I can gather, it was exactly the two situations - the liver laceration and the leak complication - that caused Dr. Joya's office to set up the complication fund - so that these types of situations would be minimized to the best of their ability. Rotten that they happened, but a good thing came of it and the complication fund was born within two months of the lacerated liver situation and two weeks after the leak complication. I think it is highly ethical to set up a way for this not to happen again. I do think it's great that a few of the other surgeons seem to cover for any complications (Aceves and Alvarez, to name two), but I'm not surprised that it's not across the board. Sometimes the surgeon has no say in what the hospital charges. He might waive HIS fee, but the hospital will charge additional fees that the surgeon often has no control over. Again, thanks for voicing your concerns, though, and for giving me the threads to read over. It's all about being armed with all the information so we can make good choices, and I APPRECIATE being armed :frown1:

Now, see, this is why I'm concerned that this is yet another one of those forums that pushes one doctor while dissing another. I can't seem to find these elusive people you speak of who have problems with Dr. Joya's ethics and have gone to see him. Who are they? Where can I find them to talk to them? Every single person I've spoken to that has gone to Dr. Joya has had nothing but good things to say about him and his staff, OR their ethics. When Gerald, his U.S. based assistant sent me the information, there was a very clear stipulation in the paperwork that talked about the complication insurance, and their policies about complications. No secrets at all there. I've talked to people who have said they went for a bypass, but Dr. Joya talked to them about the sleeve maybe being a better option for them. So is he pushing bypass, or is he simply talking to people about THEIR best options? I talked to a lady today who researched Dr. Joya for almost 10 years before finally deciding to go get a Sleeve surgery from him last year. She said she also heard rumors about the nicked liver (all the way from the patient died to the patient had issues to there was no patient), but never once could find the name of that person or talk to that person about their experience. Every single negative thing I've heard about Dr. Joya (and there hasn't been much) has been very nebulous and has no actual stats attached. Every single positive thing I've heard about Dr. Joya (and there have been many) has contained statistics and names of people. It really concerns me that this might be yet another one of those sites that promotes Dr. Aceves over any other, as if he's a sponsor of this site, and sends out negative information about other doctors, even if there is no real evidence of such happening. Yes, I've heard a couple people talk about having leaks from all of the doctors - docs don't use statistics in their stats of patients who experience issues months later, only those that experience issues early on. Did these people burst their staple lines and get leaks by overeating before they had healed? Did they begin on solids sooner than they should have? Were they anomalies? Or was it really a surgical issue? Nobody can say or give facts. Please, just let me know - I'm not here to cause trouble or whatever, but if this is another site that is going to play the "my surgeon is better than yours" game, I'll just opt out now while it's early. It is good to give people information so they can make informed choices, but only if that information is actually factual. Where is the evidence that Dr. Joya has treated people in an unethical manner? Not rumor - evidence. Thanks

Hi all - I don't have my sleeve yet, but I'm heading that way, as soon as I can solidify financing with crappy credit (compliments of my ex). I'm glad to see a forum dedicated specifically to VSG, as I'm not really a fan of the "my surgery is better'n yours" mentality that can happen in a few other forums. The only place I've never seen flaming is at Bariatrictv.com (I highly recommend the podcasts as they are funny and informative) Anyway, just wanted to say hi and that I'm glad to find this place, even if the person who sent me the PM on OH is a "deleted profile". Now I'm editing because I realized I have forgotten to give my story I'm a PRE-pre-op living in NC. I began thinking about WLS several years ago, but have been trying to get surgery since January of this year. I spent years before that telling myself "it's a cop-out" or "the easy way out" or "what's wrong with you, no willpower?" In short, I was ashamed of even thinking about that option. In my family, you just had to "tough it out." But that was then, this is now. I have battled my weight nearly all my life. I was not overweight as a child or teen. I didn't have a weight problem, but I already had an EATING problem. I was just active enough then that it didn't pile onto my thighs. I also used dexatrim, other diet pills, and street speed (yep, that desperate) to lose weight and keep it off as a teenager. Then, at age 19, I had a baby and got married, and that eating problem became apparent. My husband was emotionally distant, so I ate. I had post-partum depression, so I ate. I ate when sad, angry, happy, etc. It's no wonder considering my entire extended family were Foodies. My father owned great restaurants, and was an amazing cook, as were my stepmother and my mother, so no matter where I was, all activities revolved around food. Even funerals had tables just groaning with comfort foods like barbecue ribs, prime rib, cheesy potatoes with salty bacon, you name it. I associated food from small childhood with joy. So when I wanted to feel joy, I ate. I'm still a foodie, and love to cook, though I try to make healthier choices in what I cook these days. I've been on every diet I know about, including Atkins, Carbohydrate Addicts, Protein Power, Weight Watchers, Volumetrics, and the list goes on. I read every diet book I could get my hands on - Stop the Insanity, Atkins, French Women Don't Get Fat, even Dr. Phil's stuff, and I don't even like that guy And I discovered something - every single one of them worked. All of them had good things to say, and I lost weight on all of them. Problem was, I would lose anywhere from 10 to 60 lbs, and then gain it all back plus more. I lost a bunch about 11 years into my marriage after stepping on the scale and crying for days that I was 320 lbs. Then, I found out why my husband was emotionally distant - turned out, he was gay and faking it all those years. I was bowled over, and I started smoking again, AND eating everything in sight. We stuck it out for 10 more years (don't ask LOL), and I just vascillated. I didn't get back over 300 lbs again, but since then I have remained in the 250 to 280 range. I'm 283 right now. I got separated in 2006, divorced in 2007, and started losing weight again. Guess what? Nope, I didn't keep it off. It's not what I don't KNOW. I work in mental health, I accept the issues, I've worked on the issues, I know what to eat and I'm good at eating what I'm SUPPOSED to - but I eat too much of everything. I LOVE FOOD. All kinds, from healthy to non-healthy. And, just like the skin, if you stretch the stomach out far enough, it's not going to "spring back" into shape once you stop filling it so full. So when on a diet, I feel like i"m starving all the time. I rarely feel full, unless I've stuffed myself to the point I want to take off my pants and put on a robe. I just turned 43 years old, and I want the second half of my life to be NOT constantly losing, then gaining, then losing, then gaining. I want to be healthy, and be able to run and bike again, like I did way back when. I want to be able to play a game of tennis and not wonder if those chuckling people outside the fence are laughing at the fat chick playing tennis. Someone did say something to me once. He yelled out of the back of a pickup (and there was a CROWD of people there waiting for the annual town parade), "What are you looking at, you fat b**ch?" Me being me (already a chick with an attitude), I yelled back a line from a movie I'd remembered: "I thought it was my mother's old douchebag, but that's in Indiana!" People laughed. I put my sunglasses down over my eyes and smiled, but I was hiding the tears. I'm done feeling like I somehow don't DESERVE this, or that this is how I"m MEANT to be. I have become a confident, self-sufficient woman. I have great friends. But in this one area, I need a tool to help me. I need something that is going to make me sick if I shovel food in fast instead of savoring every bite, so I welcome dumping or feeling sick if I eat one bite too much. But I need it soon, because the second half of my life has just GOT to go better for me than the first. And I don't want to spend it struggling with food. So, hi.

I'm paying the $500 for possible complication issues, for sure. Do you have the info on the people who had any issues, so I can talk to them? I heard about the liver, but I had also seen his stats on other sites (including OH) that showed much lower complication rates than my U.S. surgeon.

thanks Efura - I'd seen on another post that Dr. Aceves was running a July special. A problem with that is that I probably won't get my passport until the end of July, as I just ordered it last week and it's taking 6 to 8 weeks right now, according to the passport website *sigh* So I can't schedule a surgery in July until I know when I'm getting my passport. ah well - and yeah, it's a great bargain - but hey, I'll get a few vacation days in a beautiful town before my surgery in PV, so it evens out

Steve - well, self-pay here would be lots more than my co-pays. But self-pay in Mexico is 1/3 the cost of self-pay here in the U.S. - at least apparently in my area - and yeah, they do know what they're doing - unfortunately, sometimes it doesn't seem all that ethical. MacM - yep; it is pretty messed up. To me, just having a little regulation would help immensely.

Thanks Ruthi and Elizabeth - it's been a long battle, and has caused a lot of stress and some depression, all the fighting for the surgery - but now I have something to get excited about! :lol0:

Yes, it IS ridiculous - the variations AND costs - one reason I'm definitely supportive of regulating our health care industry. My U.S. surgeon's fee alone would have been $12,500 - without hospital fees. I have a very close friend that got her VSG last July - same surgeon, same hospital I would have used - $36,000 total. That's for two nights in hospital and the surgery. It is horrific that they'd charge that much for two days, but there you have it. Even if my insurance HAD covered at 70% (which is what the surgeon's office told me), that would still be over $10,000 out of my pocket in the end. More than it is costing me to go to Puerto Vallarta and have it. Craziness!

I take Bariatric fusion Vitamins at present (chewables) - I haven't had my surgery yet, but I pre-ordered them back when I thought insurance would only pay for RNY. They're really good for incorporating everything in there, including zinc and Biotin, but I'm not a fan of the taste - taste like fruit flavored tums to me. Anyway, it calls for chewing 4 per day, but I'm only taking two, as I'm pre-op and I don't want to overload on Iron. I do think it is incredibly important for those of us who have weight loss surgery, even VSG without the malabsorption, to get good vitamins in. But I might not get the bariatric fusion again - bleh!

LOL - fun word, and one I like a lot - but yeah, might get me in trouble at work to say I'm "working my cock" instead of "working my tool" **snicker**

LOL MacMadame - I'm totally going to think of that now every time I hear "tool"

I find them in most grocery stores, but certainly at Super Target or Wal Mart. Dove chocolate has a bag of individually wrapped darks. Hershey's kisses does a back of dark kisses (I think they're purple wrapped, but can't remember), and Hersheys has them too in their "signature" chocolates. I like Dove myself - creamier tasting. I also like to get sugar free Chocolate pudding (or vanilla, for that matter), and freeze them in their individual cups. It really helps when I have a craving for ice cream or gellato.

You do know you can by a whole bag of just dark chocolate minis, dontcha? :biggrin0: I LOVED that invention, because the darks are what I eat, too, and one satisfies a craving, even now without the sleeve.

Exactly! :biggrin0: I think, after talking to so many people and looking at the research, the word "tool" is a very important one. Those people who consider WLS just a tool to assist them in reaching their goals, along with healthy diet and exercise, stand to have more success in the long run than those who expect it to be the end all and be all without the diet and exercise. I can have this tool and still not lose weight - by drinking high calorie shakes that pass right through, or continuing in bad habits of eating pastries or candy, or drinking drinks that are high sugar. VSG is a fabulous tool - and I can't wait to get it - but it is a TOOL that we combine with the things we already know, but struggle with doing because it can be discouraging. I'm SO looking forward to the help

I need an elliptical - easier on the joints :lol0: I need the surgery - WAY easier on the joints It's actually a good idea for those of us who cook and bake (especially in businesses, though mine is a small side business) to treat our food tasting as wine tasting. As you said, making sure it isn't (or doesn't become) a type of eating disorder on it's own.

Steve - yes, credit issues can be a pain, that's certain :lol0: I believe I might be actually getting a loan, from a very unlikely source. I have a very good friend who is a higher level computer programmer type. He pulled quite a bit of his money out of his investments just before the market started sinking like the Titanic. He's been griping for months that he's only earning about 2.5% on his money right now. He and I were talking a few weeks ago, and he questioned me a bit heavily on the credit issues and the health issues I was having. We hike together nearly every weekend, and he has, of course, noted the increasing foot and joint problems. Anyway, he has offered to loan me the money (with interest, and legally with a legal document, which I insisted on). He asked me what interest I'd expect to pay. I told him that if I got a laon from a "bad credit" creditor, the insurance would be through the roof, as high as the law allowed it. He said, "how about 6%? That's low for you, and it helps me make at least a bit more than 2.5% on that portion of my savings." It's win-win, as I have never defaulted on a loan from any source, except the ones I'm fighting that my ex ran up. So, I believe I have a lender, from an unlikely source - I didn't even bring it up to him. He offered - told me he needed his hiking buddy back so he could kick my ass fairly next time we climb a mountain here in NC. I'm making every effort to make sure it does not affect our friendship - payback will be direct deposited from my account to his on the first of each month (I pay all my bills that way anyway), so he will never have to feel like he's asking for his payment. We're still discussing it - but it sounds like it will be a go Oregondaisy - I have been looking at Dr. Aceves, as well as Dr. Alvarez and Dr. Joya (in Puerto Vallarta). All three have excellent track records and I've spoken to people who have used all three - and they all gush about all of them I've checked how many sleeve surgeries (as well as other bariatric surgeries) they have all done. I'm actually leaning toward Dr. Joya, as he is a Gastroenterologist, as well as a surgical expert, though I must say it is also for the location. The ocean has always been a place where I have gone to heal, both emotionally and physically. Expenses there even out with expenses for the other two doctors and locations, from all the adding I've been doing. And, my hiker friend and loan guy is going with me to make sure I'm okay - when he asked if someone was going, I said no, I was going alone. He volunteered to come with me on his own dime, for company and help - and because he wants to go to Puerto Vallarta LOL. I'm not completely solid on which of the three docs yet, but Dr. Joya will most likely be my choice. It's a shame so many people think that going to Mexico is so scary - these are top notch surgeons in high tech hospitals. I'm glad we're finding them before they get too popular and more expensive though

Vegasangel - yep, you get it - as I'm sure nearly all of us do You know, my issue with my ex wasn't that he was gay (well, yeah it was, but it was that he'd LIED about it and married me anyway), it was with the lying, cheating, and stealing from me. And, as yours didn't get it and said that about "at least I never told you I was fat" - mine allowed me to believe that me and my weight were the reason he was increasingly more emotionally distant, and we were having less sex (though it had never been enough). I asked him one day before I found out about his orientation - "Is it because I've gained weight, and I'm less attractive to you? Is that why you don't touch me unless I harass you for it?" He replied, "Yeah, that's it." What a coward. He destroyed what was left of my self-esteem, all to cover his own ass because he was too much of a coward to tell me the truth. Course, as we all know, I might have worked to try to lose it after that - but not really hard - and affter I found out he was gay - well, what the hell was I even TRYING to lose weight for?

Three bites protein to every one bite everything else There are lots of places to get protein besides meat and eggs. Have you ever tried edamame? It's soybeans, preferably still in the pod that they serve often at sushi or japanese places as an appetizer. You can find them in the freezer or "natural" section of most grocery stores. They are great if you sprinkle them with salt (preferably sea salt) or soy sauce and nuke them for a few - I like to eat them cold as well. It's a great high protein snack that is very low in calories and almost no fat as well. Some vegetables have higher concentrations of protein. Beans of nearly any kind are great (Taco Bell pintos and cheese is a perfect size portion for you post-surgery peeps, and it has 6 grams of protein). The world according to eggface is a great place for recipes without meat, as well as the recipes section of the forum on Bariatrictv dot com. My daughter always hated meat and eggs, so we had to get creative for her with protein when she was growing up

Another way to do it would be if you have an internet connection, and take a headset with your laptop, you can pay something like $10 to yahoo IM and phone people's real numbers from IM. It's something like 3 cents a minute, so ten bucks goes a long way.

I also had someone mention that if you work with sweets and pastries, sip on something very tart like lemonade or water with lemon juice in it while you're working, as it doesn't go well with icing and such because it's so sweet.

Thanks and yeah, I also could run a club, write a book or two about diet and nutrition, etc., as I've pretty much done it. Thing is, I've been successful at it in the past, losing up to 100 lbs at a time - but then it would come right back on the minute I stopped starving myself. Now, my metabolism is so wrecked I can be on a very strict diet and exercise regimen for a long time (my doc and I tried it - 1,000 calories a day, heavy exercise for two months - I lost 1/2 lb - talk about discouraging). So, I get it - I definitely need the restriction, because it is the hunger that drives me nuts. I want to be on the diet where I'm eating high Protein, low fat, veggies, low carbs, and I'm getting back to that now. Exercise as well - I love it - used to be an athlete, but I'm so big now that it hurts. I have foot, ankle, knee and hip soreness issues and even walking has become almost crippling for the three days after a hike. I want this tool to get that restriction. So I feel fullness without eating two lbs of food. Four bites? Lovely, bring it on :confused1:

LOL - that's gotta be hard, being a pastry chef and trying not to eat carbs :confused1: I run a small side biz, making "comfort food" casseroles for my computer geek friends in the area (they're single and don't really cook) so they aren't eating out every meal. It can be difficult not to eat it all myself - I'm pre-op, so it really is hard not to just keep packing on the pounds tasting my food. I'm remembering the mantra of a couple friends of mine - three bites Protein to one bite of anything else.

I think it depends on the surgeon and their comfort level. When I talked to Dr. Joya's helper, he stated that Dr. Joya prefers to do the surgeries separately, as there is more chance of infection in the stomach staple line should the gallbladder happen to have a problem or burst during the removal process. I've had other docs say similar things. However, my surgeon that would have been here in the states had my insurance come through would have done both at the same time. I'm going to get my VSG first, then if my gallbladder worsens, I will get thath done here, as my insurance will cover that, and it is an outpatient surgery (no overnight). Plus, they'll be able to use the VSG scar lines for gallbladder surgery as well :thumbup1:

Great post! Inspiring to hear you success stories :thumbup1: I also had thought about the band at the very beginning, but the more I researched, the more I realized that the band did not at all fit my lifestyle, not to mention the higher expense in the long run going back for fills, taking care of issues, slippage, possible erosion, port flipping, etc. and a "mini-surgery" for everything that might go wrong. I encourage all my friends with bands, and hope their bands work great for them, but it's not at all for me. I want something permanent, that doesn't require me going in for fill after fill after fill (or unfill if it's too tight). I see also the frustration of some of my banded friends who are struggling the first several months after surgery to find their sweet spots. No, VSG is for me. I'd have settled for RNY if my insurance would have paid (because they would NOT have paid for the sleeve), but they wouldn't pay for anything at all, so I'm getting VSG in Mexico. I ordered my passport on Thursday, so that's 4 to 6 weeks. Meantime, I'm still looking for the money :sad0: Thanks Wasa - great post!