Surgeon disappointed in weight loss / Bandsters a Dying Breed?

[Cleo's Mom 257]

A new woman: Your surgeon sounds like my surgeon. What did I do? I found a different surgeon about a year ago. Big difference. My new surgeon is supportive of me and actually impressed with my weight loss (my former surgeon never was). I was tired of butting heads because I'm an assertive patient. I am not intimidated by doctors. My former surgeon took my progress personally as his success or failure.

World of difference now. I left and never looked back. Consider finding another doctor. Do you really want to spend anymore time with this one?

Edited March 21, 2010 by Cleo's Mom

[Spartan 4]

I have a little different take on this than most people here.

What has been described here covers number of issues, and you really cannot dismiss it by saying the surgeon is simply a jerk. I’m not going to try and explain away what he said and did, because I was not there. But the situation does raise a few interesting issues.

First, I have to commend the Original poster on a couple of points. Congrats on the 50-pound loss. Regardless of HOW you did it, it’s a terrific achievement, and you should be thrilled about it.

Also, I do see that you are trying to make sense of your experience with your Doctor. You are trying to figure out if you are doing everything you need to be doing, which is an awesome attitude.

It’s pretty clear that this Surgeon does not possess a particularly good bedside demeanor. Or, as you suggested, he might have been having a bad day. It’s hard to tell…..we who are reading your comments were not there, so it’s hard to get a real solid sense of everything that is going on. It’s clear, though, that you are not happy about what happened.

But to characterize this Surgeon as a “Douchebag”, “Asshole”, “dick”, etc,, as some people here have done is really out of line. He might not have had a good disposition during that particular appointment, but that does NOT mean he is a bad surgeon. There were, in fact, several things that made me think he is quite good at what he does.

MANY Surgeons won’t even see you on a one-year check-up. They will leave that to the Nurse Practitioner or office staff…they just ask you a few questions, weigh you, and send you on your way. This surgeon also gave you an Upper GI….many would not, unless you were having some significant problems. But he did, AND he showed you the results. Many would not do that, they would simply tell you what the results were.

This surgeon obviously cares about the results his patients have. He may have a problem expressing it in a manner that is acceptable to you, but it does seem to be important to him. You can say that it’s a matter of pride or his “personal stats”, but whatever the reason, he DOES keep track of how his patients do, and seems to take an interest in their success or failure. Some Doctors do NOT.

As far as this discussion of him trying to “sell” you on a bypass……well….It might be entirely possible that the bypass is what you SHOULD have had, and that is why he said that to you. I do not think that it is appropriate at THIS point in time for him to be suggesting you SHOULD have had a bypass……It think it would be more constructive for him to help you work with what you DO have at this point….the Lap band. But the plain and simple fact is that the Bypass might have been a better option for you, as it is for MANY people, according to your surgeon. The various forms of Weight Loss Surgery are meant for different people, and I am saying this here only because of some of the comments made by people who clearly do not “get” this concept. He clearly feels this way.

The other reason I mention the Bypass issue here is that if it IS true that the Bypass would have been the preferred surgery for you, then you need to realize that you might have to work a bit harder to lose the additional weight with the Lap Band. The Lap band utilizes restriction as the mechanism for Weight Loss, and the Bypass uses malabsorbtion to facilitate the weight loss, with some restriction as well..….two totally different approaches. This is important to understand because for someone who really needs Malasorbtion to lose weight (as your surgeon has suggested you do), then it’s going to be harder doing it with restriction alone. It CAN be done….it’s just more difficult, and will take some additional time and effort.

You indicated that you exercise a lot. If you do indeed walk 2 miles a day, and do the other exercises you mentioned on a very regular basis, and are making good food choices, it COULD be argued that you should have lost a bit more weight than you have, IF you were a good Lap Band candidate. But the reality is that it is hard to say. People lose weight at widely varying rates, with or without Weight Loss Surgery.

As far as your second question, is the band being replaced by the Bypass….well, no, not really. But the Lap band is NOT the “darling” of the Bariatric industry the way it was a couple of years ago. Incidence of erosion, slippage, and other types of complications and “malfunctions” have been increasing, mainly because the population of Band patients has been getting larger and there are more long-term patients that are having their band removed due to these complications. There is a growing consensus that the Lap Band will ultimately be considered more as a 3 to 5 year temporary solution, rather than a long-term/lifetime solution. Insurance companies are beginning to see this as well. The declination rate for Lap band requests is increasing because the Lap band, while successful in many instances, is not in many cases as well.

So, what’s the take-away from all of this for the OP? Well, contrary to some of the opinions expressed in this thread, I’m not all that sure you have a bad Doctor.(and this is coming from someone who has enormous contempt for the medical establishment as a whole) He might not be as supportive as you would like, and he might have made some observations that were not all that appropriate, but he has also done some things that would suggest that he does care about how his patients turn out. I will tell you that I have been through numerous surgeries and procedures over the last decade, and I have had enormous damage done to me by surgeons who did not know quite what they were doing. So, I have come to value Competence FAR more than Congeniality. I’m not saying that bedside manner is not important for some people, but for me it is a non-issue.

I am a very firm believer in doing EXACTLY what your surgeon tells you to do, for a variety of reasons. However, there are instances where your surgeon does not TELL you anything. When this happens, you have to be a little more proactive. You need to demand some answers from your Surgeon on exactly what you SHOULD be doing, or you need to venture elsewhere to get the information that you need to be successful. One of the secrets to a successful Bariatric surgery experience is to find the right surgeon, one that has deep experience in the surgery you are going to have, one that has a deep background in Nutrition (and many of the newer breed of Bariatric surgeons do have that expertise), and one who has a staff that will provide a high level of support and information for you post-surgery. You might be able to get that from your present surgeon if you ask/demand it, but if you don’t, do NOT be afraid to go elsewhere. If this is what you decide to do, take your time, and find someone who is everything you want and need.

Having said all that, you’ve done great so far….keep it up, and I wish you success in whatever you end up deciding to do.

[Spartan 4]

The bypass is for people that want to lose weight without any effort.

That is one of the most ignorant statements I have ever seen on any WLS Board.

ALL of the various weight loss surgeries require work and effort. They are ALL difficult, in different ways.

[chrisdirects 0]

I'm so sorry you had that experience. I worked for doctors in various specialties for many years, and although they all coped with the stress of being physicians in different ways, they were never abusive to their patients. It sounds to me as if he's more worried about his personal "success rate" than he is about you...and with such a great loss, you should be one of his shining stars.

What perhaps he didn't say, and should have, is that, although banding patients do not lose as fast as those who have more radical procedures, over the long haul, we catch up to the others...with a lot fewer complications and side issues to have to deal with.

I agree with everyone who has posted...you deserve more support, not less. Find yourself a surgeon or facility that is focused on YOU.

Best wishes, hon,

Christine

[A New Woman 1]

I have a little different take on this than most people here.

What has been described here covers number of issues, and you really cannot dismiss it by saying the surgeon is simply a jerk. I’m not going to try and explain away what he said and did, because I was not there. But the situation does raise a few interesting issues.

First, I have to commend the Original poster on a couple of points. Congrats on the 50-pound loss. Regardless of HOW you did it, it’s a terrific achievement, and you should be thrilled about it.

Also, I do see that you are trying to make sense of your experience with your Doctor. You are trying to figure out if you are doing everything you need to be doing, which is an awesome attitude.

It’s pretty clear that this Surgeon does not possess a particularly good bedside demeanor. Or, as you suggested, he might have been having a bad day. It’s hard to tell…..we who are reading your comments were not there, so it’s hard to get a real solid sense of everything that is going on. It’s clear, though, that you are not happy about what happened.

But to characterize this Surgeon as a “Douchebag”, “Asshole”, “dick”, etc,, as some people here have done is really out of line. He might not have had a good disposition during that particular appointment, but that does NOT mean he is a bad surgeon. There were, in fact, several things that made me think he is quite good at what he does.

MANY Surgeons won’t even see you on a one-year check-up. They will leave that to the Nurse Practitioner or office staff…they just ask you a few questions, weigh you, and send you on your way. This surgeon also gave you an Upper GI….many would not, unless you were having some significant problems. But he did, AND he showed you the results. Many would not do that, they would simply tell you what the results were.

This surgeon obviously cares about the results his patients have. He may have a problem expressing it in a manner that is acceptable to you, but it does seem to be important to him. You can say that it’s a matter of pride or his “personal stats”, but whatever the reason, he DOES keep track of how his patients do, and seems to take an interest in their success or failure. Some Doctors do NOT.

As far as this discussion of him trying to “sell” you on a bypass……well….It might be entirely possible that the bypass is what you SHOULD have had, and that is why he said that to you. I do not think that it is appropriate at THIS point in time for him to be suggesting you SHOULD have had a bypass……It think it would be more constructive for him to help you work with what you DO have at this point….the LAP-BAND®. But the plain and simple fact is that the Bypass might have been a better option for you, as it is for MANY people, according to your surgeon. The various forms of Weight Loss Surgery are meant for different people, and I am saying this here only because of some of the comments made by people who clearly do not “get” this concept. He clearly feels this way.

The other reason I mention the Bypass issue here is that if it IS true that the Bypass would have been the preferred surgery for you, then you need to realize that you might have to work a bit harder to lose the additional weight with the LAP-BAND®. The LAP-BAND® utilizes restriction as the mechanism for Weight Loss, and the Bypass uses malabsorbtion to facilitate the weight loss, with some restriction as well..….two totally different approaches. This is important to understand because for someone who really needs Malasorbtion to lose weight (as your surgeon has suggested you do), then it’s going to be harder doing it with restriction alone. It CAN be done….it’s just more difficult, and will take some additional time and effort.

You indicated that you exercise a lot. If you do indeed walk 2 miles a day, and do the other exercises you mentioned on a very regular basis, and are making good food choices, it COULD be argued that you should have lost a bit more weight than you have, IF you were a good LAP-BAND® candidate. But the reality is that it is hard to say. People lose weight at widely varying rates, with or without Weight Loss Surgery.

As far as your second question, is the band being replaced by the Bypass….well, no, not really. But the LAP-BAND® is NOT the “darling” of the Bariatric industry the way it was a couple of years ago. Incidence of erosion, slippage, and other types of complications and “malfunctions” have been increasing, mainly because the population of Band patients has been getting larger and there are more long-term patients that are having their band removed due to these complications. There is a growing consensus that the LAP-BAND® will ultimately be considered more as a 3 to 5 year temporary solution, rather than a long-term/lifetime solution. Insurance companies are beginning to see this as well. The declination rate for LAP-BAND® requests is increasing because the LAP-BAND®, while successful in many instances, is not in many cases as well.

So, what’s the take-away from all of this for the OP? Well, contrary to some of the opinions expressed in this thread, I’m not all that sure you have a bad Doctor.(and this is coming from someone who has enormous contempt for the medical establishment as a whole) He might not be as supportive as you would like, and he might have made some observations that were not all that appropriate, but he has also done some things that would suggest that he does care about how his patients turn out. I will tell you that I have been through numerous surgeries and procedures over the last decade, and I have had enormous damage done to me by surgeons who did not know quite what they were doing. So, I have come to value Competence FAR more than Congeniality. I’m not saying that bedside manner is not important for some people, but for me it is a non-issue.

I am a very firm believer in doing EXACTLY what your surgeon tells you to do, for a variety of reasons. However, there are instances where your surgeon does not TELL you anything. When this happens, you have to be a little more proactive. You need to demand some answers from your Surgeon on exactly what you SHOULD be doing, or you need to venture elsewhere to get the information that you need to be successful. One of the secrets to a successful Bariatric surgery experience is to find the right surgeon, one that has deep experience in the surgery you are going to have, one that has a deep background in Nutrition (and many of the newer breed of Bariatric surgeons do have that expertise), and one who has a staff that will provide a high level of support and information for you post-surgery. You might be able to get that from your present surgeon if you ask/demand it, but if you don’t, do NOT be afraid to go elsewhere. If this is what you decide to do, take your time, and find someone who is everything you want and need.

Having said all that, you’ve done great so far….keep it up, and I wish you success in whatever you end up deciding to do.

Thank you for your very thought provoking post. I can tell you put a lot of thought and effort into your response. I don't necessarily think my surgeon is a bad surgeon. That's why I haven't jumped on the bandwagon yet to get a new surgeon. Until this last visit, I didn't see him in this light before. And I've really been trying to think of why he was so negative. As I've said before, I think he feels that I push too hard for fills and that he was reluctant to give me a fill and I didn't push for it at all. I was really, truly on the fence as to whether or not I needed one. And I was disappointed in myself in the past for not losing more. But at this particular visit I was quite proud that in a year I lost over 50 lbs. The average weight loss advertised for the bands is 1-2 lbs. a week, so I do fall in the average -- the low end of the average but still average. So I thought he would at least feel I was successful. I don't necessarily think that bypass was a better surgery for me with the exception that the weight loss would have been faster. I chose the band because I wanted a surgery that was reversible if I had complications and I knew it was a slower a weight loss and that it was a tool to use. Do I occasionally get frustrated myself with the rate that I lose? Sure, but I think most of us do at some time or another. I truly, truly think that this particular surgeon just prefers the bypass based on the results over the band and that he does view it as a personal failure. Especially since he told me that he only does 5% of his patients now as band. He obviously encourages bypass over band. As far as my exercise goes, I didn't mean to imply I do all those things every day. After my surgery I started walking and I walked at least 5 times a week 2 miles. In Sept I joined a kickboxing class 2 times a week and I would supplement that with still doing my walking on nice days until November. I then started doing a Kathy Smith kickboxing tape when the weather turned and did that to supplement my classes. In January I joined both a Zumba (2x's a week) and kickboxing (down to 1x a week) and then was doing the Wii I got for Christmas on other days. About a month ago my sciatic nerve started to bother me so I have reduced my workouts but until the last month I consistently exercised at least 5 days a week, and I told the doc that my exercise declined due to my sciatic (which I now have a Physical Therapy appt scheduled soon to start to correct). Exercise, combined with what I thought were still too large portions, yes, at times I felt I needed a fill and maybe that rubbed him the wrong way. I do think that he was having a very bad day because when he didn't believe me about not smoking it just went downhill from there. And it made me feel like he didn't believe me about anything else I was telling him either. I would have loved if he would have said "you can do this Lisa, you're doing great. If you lose the next 40 lbs in the year, that'll be great." Anything to support me and make me feel like I'm a success. But in all honesty, I didn't hire a cheerleader, I hired a surgeon and most doctors just don't have the bed-side manner we crave. Today, I saw a co-worker who has been off work for serious health reasons for 5 months. The first thing she said when she saw me was "You look GREAT!" She wanted to talk about me and not about her own health, which I was thrilled with how good she looked. She validated my success so much. Nearly every day someone says something to me about my weight loss. So I have to remember that my battery gets charged elsewhere and not look to him to recharge it. Maybe I just expected too much. I do appreciate you and everyone on here for your honesty and for your support and helping me feel like a success. I needed that stroking and I think everyone expressed anger at my surgeon out of care for me so I really feel the love on this post from everyone. Thank you.

[Spartan 4]

Lisa, I think you have very positive and reasonable outlook on all of this. And, the bottom line is that YOU are the ONLY one that needs to be satisified with the rate of loss. You do not need to satisy your Doctor.....only yourself, and it seems that you are doing that.

As far as "averages" and rate of loss and all of that, you see a lot of different statistics and percentages tossed around about what is "normal" or "expected". But the real truth is that there are NO large-scale studies that have been performed from which to draw any meaningful statistics on ANY of the Weight Loss procedures. People (including some Doctors) love to regurgitate stats that they have read somewhere on the internet or in some brochure, but the reality is that they do not exist. Some states compile limited stats, some medical trade organizations gather some data, but the fact remains that most of the numbers we hear are simply guestimates used to support someone's idea that one procedure is better than another. Several people on this thread have tossed out the same old numbers that they got from another web site, who got it from another web site, and so on.

My point is that results from ALL of the Surgeries vary wildy, and depend on SO many things, such as surgeon experience, post-surgical patient compliance, the TYPE of Lap Band that was used, whether it was filled at placement, etc, etc. And the absolute bottom line is what YOU as the patient are going to do to create your own success.

And it sounds to me like you want to MAKE your success happen, and that is 90% of the battle.

I am not sure you should give up on your surgeon yet. Perhaps a talk with him, or his office staff might make a difference in how he deals with you.

I think, based upon everything you have said here, that you are going to be a resounding success in this. Most people do not put as much thought into their entire Lap Band experience as you have put into this single interaction, and I think that this indicates that you will end up EXACTLY where YOU want to be!

Keep us posted!

[babsy 0]

Firstly, congratulations on your great loss.

What I have read so far raises a couple of questions for me.

One thing I haven't picked up from this thread is what has this doctor been like at your previous visits? Is he usually supportive, and this day was just one bad day? In that case, I can see why you might want to persevere with him, and try to understand where he was coming from.

However, this is YOUR weight loss journey, not his. Did he ask you if you were happy with 50 lb, or if you felt like you needed help to achieve a greater loss?

This site keeps reinforcing that the band is a tool we use, but so is our doctor supposed to be in partnership with us. He is not supposed to be the big boss with a stick to punish us if we are "bad", or a bully who tries to make us feel bad about ourselves if we don't reach the goals he set (not our goals). He should be helping us reach our goals, with good advice, and we should be trusting each other.

If you feel that this was a lapse from an otherwise good doctor, it's OK to go back and try again. However, remember you are paying him to help you. If you don't get the service you are paying for, for whatever reason, or you no longer feel comfortable with him, find another doctor, and write a letter to let him know why. This is about you. If you need a doctor who is supportive, get one. Maybe he is a great surgeon, but not good on the follow-up side of things. If so, you've had the surgery, you are successfully losing weight at a healthy rate, and might not need him any more.

Personally, I expect more than just someone who can competently perform surgery. If he chose to specialise in bariatric patients, he should be prepared to give them the long-term support and follow-up required.

Good luck with your decisions and the rest of your weight loss.

[TracyNYC 4]

Theat's funny since my surgeon says he does almost all bands now! What an ass. I would definitely follow upo and say something to him about his attitude.

[A New Woman 1]

Firstly, congratulations on your great loss.

What I have read so far raises a couple of questions for me.

One thing I haven't picked up from this thread is what has this doctor been like at your previous visits? Is he usually supportive, and this day was just one bad day? In that case, I can see why you might want to persevere with him, and try to understand where he was coming from.

However, this is YOUR weight loss journey, not his. Did he ask you if you were happy with 50 lb, or if you felt like you needed help to achieve a greater loss?

This site keeps reinforcing that the band is a tool we use, but so is our doctor supposed to be in partnership with us. He is not supposed to be the big boss with a stick to punish us if we are "bad", or a bully who tries to make us feel bad about ourselves if we don't reach the goals he set (not our goals). He should be helping us reach our goals, with good advice, and we should be trusting each other.

If you feel that this was a lapse from an otherwise good doctor, it's OK to go back and try again. However, remember you are paying him to help you. If you don't get the service you are paying for, for whatever reason, or you no longer feel comfortable with him, find another doctor, and write a letter to let him know why. This is about you. If you need a doctor who is supportive, get one. Maybe he is a great surgeon, but not good on the follow-up side of things. If so, you've had the surgery, you are successfully losing weight at a healthy rate, and might not need him any more.

Personally, I expect more than just someone who can competently perform surgery. If he chose to specialise in bariatric patients, he should be prepared to give them the long-term support and follow-up required.

Good luck with your decisions and the rest of your weight loss.

Thanks for your reply. In past visits he was not this negative. Did he ask if I was happy with the results? No. But when I sensed that he was not happy with my results, I told him I was happy and proud and came right out and said "Dr X, I have lost a little over 50 lbs in a year. Isn't that good?" To which he replied "good but not exceptional." This is what I plan to do. The nurse that first saw me was a new nurse. His regular bariatric nurse (whose also a bariatric bypass person) and has been with him for a long time was on vacation. She comes back in a week. I am going to call her and talk to her and let her know how I felt and go from there.

[LeighaMason 19]

To which he replied "good but not exceptional."

This reply makes me think he just has personal issues giving credit. I find that people who are like this sometimes had a parent they learned it from.

"Dad, I got a 98 on my test!"

"Son, What happened to the other 2 points?"

So they try harder. Some people respond to this type of negative reinforcement and maybe its what he grew up with. Maybe in some odd way he is trying to motivate you.

[BetsyB 9]

Spartan, are you a physician?

[Diamondgirl81 0]

For what it's worth, I see a doctor who is listed on all of those top doc listings each year. He'a brilliant surgeon with a great success rate, but questionable bedside manner. Most people in my support group agree that while he is a great surgeon, he can be very abrasive. To that end, he is also a pioneer in the field of the gastric sleeve. He is the gold standard when it comes to that particular procedure. He wrote the book. Last week, I saw him for my three month follow-up, he told me I was doing great, just remember to exercise, exercise, exercise, and that will see me through to the rest of my goal. He gave me a slight fill and sent me on my way. However, 5 minutes before I saw him, I heard a doctor talking to a new patient. The gentleman had about 100 lbs to loose and wanted a surgery w/ the EASIEST follow-up & lifestyle. I think I heard the word easy in about 10 different ways. Of course, the "easiest" follow-up care is w/the sleeve. There are no fills, not many follow-up appointments, and no foreign objects in the body to worry about. However, to me, there is NOTHING easy about removing 60% of my stomach or w/ bypass, rerouting my intestines. I'm not against any of these procedures at all. We all came to a point where we realized we needed some sort of help. However, I am strongly against marketing any of these procedures as an EASY option. Tying this back into the thread, I believe we get out of these procedures, what we put into them. Regardless of the path we take.

Best to all on this journey.

Lauren

[Awkward customer 5]

New Woman, that doctor was just rude. If I were you I would try to see someone else next time. How dare he say "all I can smell is smoke on you"? I would be tempted to be harsher in my replies to such a person: "I have stated I don't smoke, and I expect you to believe me. Don't raise the subject again, and try to be more professional in your dealings with patients, thank you!"

Your choice of lunch is not terrible. 3 chicken fingers and mashed potatoes? Well the potatoes are filling, and as long as you are keeping to a calorie total per day, chicken fingers and mashed potatoes are quite adequate. Having a band does not mean that you have to have vegetables only every day for the rest of your life. He is just being unreasonable. Really, he is talking to you like a child.

If you are happy with your weight loss, and it is working for you, even if slightly more slowly than the doctor expected, you haven't got a problem. Just get rid of the doctor.

[jalomum 1]

IMHO you are doing everything right, you are eating well, taking exercise and still losing consistently. That is the tool in your tummy being used perfectly. It's an awesome weight loss at a steady pace and you are allowing your body to adjust on the way down.

No starvation, PBing, or slowing of metabolism through low intake and too much exercise...all added stress on our already strained bodies. Very admirable. Slow and steady wins the race.

Yes you could lose it faster but you would also have a harder time of it and have to push yourself really hard, you could make it the focus of yourlife to the exception of all else. But why? The way you are doing it means that the changes you have made will probably stick for life and you get to live a normal life while you make these humoungous steps forward.

Way to go honey!! Top job!

I have a banded acquaintance who has lost around 80kgs in a year! Awesome, exceptional, incredible...now she daren't have the fill removed because she is scared it will all go back on. For the last 6 months all she has been able to eat is thick Soup and maybe some miniscule chopped up Pasta, everything else comes back up. Oh yes and chocolate and ice cream of course. Exceptional weight loss...horrific habits and now she has lost all her excess weight and still does not know how to eat properly. She has not seen her surgeon in a year and daren't in case he insists she has her fill out.

Surgeons like your's should walk a mile in our shoes before they underestimate our achievements and progress, they should examine the developing food habits and emotional factors too.

You look lovely in your photos too, what a change!

My advice: keep doing what you're doing and find another doc to do your fills, tell him why you no longer require his services. If you keep going to him he will treat others like this too and not realise he is a source of negative feelings. Change docs and make sure both he and your new doc know why.

My surgeon is brill but the doc he used to do the fills was someone who treated me as though I had no brain and no understanding of anything. I used to get really upset knowing I had to go see him. There are now 2 other docs I can see and they are really nice. I have explained to both them and the receptionists that this other doc's manner and methods are offensive to some people. Motivation and information from him was in army style and he expected the 'Sir, Yes Sir' reply too. Get over it! It was that bad that if I had to see him I would just cancel and re-book.

[babsy 0]

Spartan, are you a physician?

Betsy, that was my immediate question to myself.

Barb