Researching Mexican Sleeve Surgeons

WASaBubbleButt · June 3, 2009

(This will work for Mexican or US Sleeve surgeons)

RESEARCHING MEXICAN DOCTORS 101

Getting a Vertical Sleeve Gastrectomy/Sleeve Procedure

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 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.