My suspicion about pre-op diets and surgeons

[crosswind 134]

On another topic I was posting my brilliant musings about surgeons and pre-op diets and I wanted to say this because sometimes I'll answer a post and it will sound like I'm stating some authoritative opinion when I'm really thinking out loud.

I've been watching these boards for a couple of months and looked into getting surgery in my home state but it was very expensive. I knew it was going to be but then I realized the other thing I really did not want to deal with was six months of "pre-op" nonsense. I realized this when I contacted Dr. Aceves' office a second time and spoke to his patient coordinator, who was very direct but also very clear about what was truly necessary and what was not. In their practice. My pre-op is a week long lowcarb diet. I had to quit smoking ten days beforehand and start blowing up balloons. She told me about many other patients, their concerns, what could possibly come up, and why they needed me to do what they needed me to do.

Dr. Aceves has performed over 600 sleeves with very few complications as far as I can tell. I know of one rumored leak and then another phantom guy who came on here and said he almost died and that translates to a .03 serious complication rate for his sleeves. Yet his pre-ops are pretty lenient. I can use NRT. I did not need a psych evaluation. I put down my deposit, bought a plane ticket and was scheduled two weeks from that date. If Dr. Aceves were this lenient and he was sending people home half-dead, I would be suspicious. But he does appear to know what he's doing and there is a strong track record behind his methods so I'm happy to do what he tells me to do.

One other thing I noticed is that less people come around, online, on youtube, on boards like this and describe serious early or late complications of any kind if they've come from Dr. Aceves. Now either he is paying off his broken patients off or he is rolling the dead ones up in rugs and driving them into the desert for the coyotes -- OR more people are coming away pretty much whole when he is done with them. Which leads me to my suspicion about a number of surgeons in the US who are approveable by insurance: some of these people -- not all, I haven't done any data mining in this regard -- but unscientifically it seems some of these surgeons just have not done many sleeves and so they have to learn the hard way -- on us.

One way to mitigate potential disaster in that case is to make the patient's pre-op extremely rigorous. For example, a surgeon might say he can't operate on you until you lose ten percent of your body weight -- why is that? Because the literature and the insurance actuarial studies have said that this lessens risk by some margin, and it's possible that without certain patient requirements the hospital or the doctor will not be paid the insurance portion of the procedure. Also - surgeons work how they need to work - if he has learned to do the surgery using a 48 bougie on patients with very tiny livers who are under 45 BMI, these are the only people he is going to operate on. I am not faulting a surgeon who has only done a couple surgeries for doing another one -- he'll do what he needs to do to be reasonably sure his patient is going to live through it. But as of 2008, three years ago, a local news story on the sleeve said that " only a few surgeons in the country" knew how to do this procedure.

Anyway my suspicion is that your pre-op diet reflects what reassures the surgeon according to certain criteria and what will appease your insurance company. Whether it is specifically *necessary* to do the operation is another thing. It's the only logical conclusion I can come to based on what I've been reading. Why would a person need to lose ten percent of his body weight *before* surgery? It makes no sense -- but it might make sense according to some JAMA study the insurance companies like.

The other thing I've noticed is that while Dr. Aceves' pre-op is not the most rigorous in the world -- his POST-OP is incredibly strict. Why? Because complications don't occur before surgery. They occur afterwards. That's why his patients ( and some others I'm sure) leave the hospital on Clear liquids for ten days, not three. Or more actually. It seems like the majority of post-op complications come from patient noncompliance some time after surgery, like the person who goes to a barbecue three days out and attempts chili. It seems more important that you don't do that than *anything* you do beforehand within reason.

So what it comes down to is this -- at this point this surgery is unique to the surgeon. His experience, whatever pressures there are from the money or the hospital, and his specific expertise in punching you open and refashioning your internal organs. And this is why I say the American system is fuqed. It would all be so much easier if some of those pressures were lessened, and insurance didn't put so many roadblocks in the way -- not just for patients but for the whole procedure.

Thats what I think!

[KinkySlinky 3]

This is my take on it...

A lot of requirements here that are done by the surgeon is really because of, aside from complications, LIABILITY.. Now, I'm no lawyer or anything but... You can try suing a Mexican surgeon, but I'm really not sure how far you will get with that, you know?

Now, I'm not saying he's a bad surgeon or anything of the sort... but quite a few of the hoops we have to do here in the U.S. is because people are just too sue-happy... Medical malpractice is a joke... If they make you do everything in their power to prevent any complication, it makes it harder to win a malpractice suit...

As far as the insurance hoops... Those are set in place by the employer.. Not the insurance company..

I agree it's ridiculous... But unfortunately, a lotta times it's necessary protection for the surgeon....In fact my surgeon is 1 week liquids pre-op, and THREE weeks of liquids post op... He's also done just under 1000 sleeves since 12/06 (or so he says).. he averages a lil over 900 procedures per year.. There are good doctors everywhere, you just gotta find them... and you're right about how surgeons will do what they've been taught... Most patients have a larger incision on the left (from what I've read), but my surgeon prefers to have the larger incision on the right side.. Different technique...

Good luck to you!!!!!!!!

[AutumnLily 77]

Crosswind 600 sleeves for Dr. Aceves seems a low number. I am sure when I checked many months ago that it was higher than that.

[Disney 20]

Crosswind 600 sleeves for Dr. Aceves seems a low number. I am sure when I checked many months ago that it was higher than that.

You're right AutumnLily, the count I saw when I started researching Dr. Aceves was over a 1100 back in November. I am sure it is over 1500 by now. He did about 10 in the 4 days I was there, and the day I had surgery, he only did me, the only other patient was getting bypass.

His post-op is days 1-5 Clear Liquids, days 6-10 thin liquids (not much different than the clear stage), days 11-20 full liquids (so basically THREE weeks liquids) then days 21-30 soft foods (mushies), then days 31 forward solid foods.

And to comment on Kinky's post, as she said, the Dr.'s in the states are so thorough so that they are harder to "sue" if something happens. And it's true, you pretty much cannot sue a Dr. in Mexico but if you can't win a suit in the states, how are you better off?

I was self-pay and could have gone to pretty much any surgeon I wanted, (within reason) but I chose Dr. Aceves because of his track record and skill. He has proven himself over and over. I wanted a surgeon who could do this surgery with his eyes closed. I trusted him and he did not fail me. I have also never met a more caring Dr. in my entire life. Or with such a good bedside manner. I have no tolerance for Drs who think they are gods. I like a Dr. who will sit right down with me and look me in the eyes and explain things to me, and help me when I have questions, etc. Not just breeze in and breeze out in about 2 minutes. The day I left the hospital, the last thing Dr. Aceves said to me was, "Thank you for your confidence". He KNOWS how most people view Mexican Drs and he is trying, one patient at a time, to change the negative rap that most of them get. I will gladly tell everyone I see who did my surgery and recommend him to all.

[Oregondaisy 2,021]

Dr. Aceves is the BOMB!

I bet a lot of people did not know that he goes to other countries and teaches other surgeons to do the sleeve. He has taught a lot of American

surgeons.

[Bryn 3]

the legalities between an american certified doctor is quite different than that of one in a foreign country. kind of how so many people go to asian countries to get plastic surgery or other elective surgeries; cheaper, no insurance approval, very hard to sue them if something were to go wrong.

there has to be standards set in place. especially with insurance companies. i've met many doctors who have stated that even if their patient is paying OOP, that they must follow their program plan. Like KinkySlinky mentioned, it's liability. Doctors want to /decrease every possible risk of anything happening. People here in america are sue happy; they'll sue for anything and everything. Doctors are already spending a ton in malpractice insurance, so it's only right they "demand" every possible test, weight loss, exercise regiment to happen.

I think of it this way, if an orthopedic doctor needed to perform a knee replacement on a 400lb 6' male, he would demand he lose weight first to make the surgery easier, and increase the chance of a speedier/healthier recovery. If a bariatric surgeon is willingly going to perform a surgery on a patient, they want to make sure that patient makes them look good as well. No doctor wants a failed patient. So when a doctor says "you should try and lose 15 lbs before surgery", it's saying that the doctor wants to see some effort on the patients part. losing weight helps decrease the size of the liver so the doc doesn't have to struggle while in.

Don't get me wrong, I don't know crap about Dr. Aceves so I can't comment on him and his practice. I'm sure he's a fine doctor; or else no one would think so highly of him. Or maybe I'm completely biased because I work in healthcare and I know how much professionals need to protect themselves so these pre-requisites are necessary to keep all parties "safe". Maybe some tests aren't necessary, I feel all the tests i had this far were quite necessary.

Everyone has their own opinion and everyone has to do their own research. Nice to see that you have done yours and quite honestly, you've supported your claims and opinions; nothing wrong with that. Not every doctor is alike, so it's up to us as consumers to do our research and also protect ourselves.

[crosswind 134]

This is my take on it...

A lot of requirements here that are done by the surgeon is really because of, aside from complications, LIABILITY.. Now, I'm no lawyer or anything but... You can try suing a Mexican surgeon, but I'm really not sure how far you will get with that, you know?

Now, I'm not saying he's a bad surgeon or anything of the sort... but quite a few of the hoops we have to do here in the U.S. is because people are just too sue-happy... Medical malpractice is a joke... If they make you do everything in their power to prevent any complication, it makes it harder to win a malpractice suit...

As far as the insurance hoops... Those are set in place by the employer.. Not the insurance company..

I agree it's ridiculous... But unfortunately, a lotta times it's necessary protection for the surgeon....In fact my surgeon is 1 week liquids pre-op, and THREE weeks of liquids post op... He's also done just under 1000 sleeves since 12/06 (or so he says).. he averages a lil over 900 procedures per year.. There are good doctors everywhere, you just gotta find them... and you're right about how surgeons will do what they've been taught... Most patients have a larger incision on the left (from what I've read), but my surgeon prefers to have the larger incision on the right side.. Different technique...

Good luck to you!!!!!!!!

See, now, I would totally go with that guy because he's done eleven hundred of the things. In my home state I asked about that and they told me that surgeon had done five hundred bariatric procedures, and when I asked how many sleeves two nurses at that office said they "weren't sure." And I agree about the malpractice.

[crosswind 134]

You're right AutumnLily, the count I saw when I started researching Dr. Aceves was over a 1100 back in November. I am sure it is over 1500 by now. He did about 10 in the 4 days I was there, and the day I had surgery, he only did me, the only other patient was getting bypass.

1100? All the better! Don't me wrong, I'm not bragging personally about Dr. Aceves - I haven't met him yet. I was really just using him as an example of the difference in techniques and requirements among successful surgeons. From some of the posts I've read all over the place, some of these guys have their patients sweating bullets for months when the real issue is whether the surgery was a success, and whether post-op compliance was met. It seems...extraneous.

[crosswind 134]

Actually I think the real true reaason for the pre-op diet is because if I wasn't on it I would do what any normal fat or thin person would do if you told them they would not be able to eat for a month and then very very carefully forever thereafter. I would go insane trying to stuff everything in my mouth I would tell myself I would never taste again. If you want to make an obsessive overeater out of anyone, just tell them the world will be all out of food next week...

[OnTheFenceMomma 0]

On another topic I was posting my brilliant musings about surgeons and pre-op diets and I wanted to say this because sometimes I'll answer a post and it will sound like I'm stating some authoritative opinion when I'm really thinking out loud.

I've been watching these boards for a couple of months and looked into getting surgery in my home state but it was very expensive. I knew it was going to be but then I realized the other thing I really did not want to deal with was six months of "pre-op" nonsense. I realized this when I contacted Dr. Aceves' office a second time and spoke to his patient coordinator, who was very direct but also very clear about what was truly necessary and what was not. In their practice. My pre-op is a week long lowcarb diet. I had to quit smoking ten days beforehand and start blowing up balloons. She told me about many other patients, their concerns, what could possibly come up, and why they needed me to do what they needed me to do.

Dr. Aceves has performed over 600 sleeves with very few complications as far as I can tell. I know of one rumored leak and then another phantom guy who came on here and said he almost died and that translates to a .03 serious complication rate for his sleeves. Yet his pre-ops are pretty lenient. I can use NRT. I did not need a psych evaluation. I put down my deposit, bought a plane ticket and was scheduled two weeks from that date. If Dr. Aceves were this lenient and he was sending people home half-dead, I would be suspicious. But he does appear to know what he's doing and there is a strong track record behind his methods so I'm happy to do what he tells me to do.

One other thing I noticed is that less people come around, online, on youtube, on boards like this and describe serious early or late complications of any kind if they've come from Dr. Aceves. Now either he is paying off his broken patients off or he is rolling the dead ones up in rugs and driving them into the desert for the coyotes -- OR more people are coming away pretty much whole when he is done with them. Which leads me to my suspicion about a number of surgeons in the US who are approveable by insurance: some of these people -- not all, I haven't done any data mining in this regard -- but unscientifically it seems some of these surgeons just have not done many sleeves and so they have to learn the hard way -- on us.

One way to mitigate potential disaster in that case is to make the patient's pre-op extremely rigorous. For example, a surgeon might say he can't operate on you until you lose ten percent of your body weight -- why is that? Because the literature and the insurance actuarial studies have said that this lessens risk by some margin, and it's possible that without certain patient requirements the hospital or the doctor will not be paid the insurance portion of the procedure. Also - surgeons work how they need to work - if he has learned to do the surgery using a 48 bougie on patients with very tiny livers who are under 45 BMI, these are the only people he is going to operate on. I am not faulting a surgeon who has only done a couple surgeries for doing another one -- he'll do what he needs to do to be reasonably sure his patient is going to live through it. But as of 2008, three years ago, a local news story on the sleeve said that " only a few surgeons in the country" knew how to do this procedure.

Anyway my suspicion is that your pre-op diet reflects what reassures the surgeon according to certain criteria and what will appease your insurance company. Whether it is specifically *necessary* to do the operation is another thing. It's the only logical conclusion I can come to based on what I've been reading. Why would a person need to lose ten percent of his body weight *before* surgery? It makes no sense -- but it might make sense according to some JAMA study the insurance companies like.

The other thing I've noticed is that while Dr. Aceves' pre-op is not the most rigorous in the world -- his POST-OP is incredibly strict. Why? Because complications don't occur before surgery. They occur afterwards. That's why his patients ( and some others I'm sure) leave the hospital on Clear Liquids for ten days, not three. Or more actually. It seems like the majority of post-op complications come from patient noncompliance some time after surgery, like the person who goes to a barbecue three days out and attempts chili. It seems more important that you don't do that than *anything* you do beforehand within reason.

So what it comes down to is this -- at this point this surgery is unique to the surgeon. His experience, whatever pressures there are from the money or the hospital, and his specific expertise in punching you open and refashioning your internal organs. And this is why I say the American system is fuqed. It would all be so much easier if some of those pressures were lessened, and insurance didn't put so many roadblocks in the way -- not just for patients but for the whole procedure.

Thats what I think!

I know you're just thinking and writing, not really filtering. I can accept that. I do have a couple of things to say though.

1. Most people I know can't afford to pay out of pocket for trip to Mexico for surgery which is paid for out of pocket. Insurance is the only way to get this paid for and if that's what it takes, I'll kiss their butts and make them a sandwich.

2. I wouldn't want my surgeon so far away. I want access for follow up.

3. Most of the posts and video's I've seen from people who go to Mexico say how easy it is. This scares me. It seems very "assembly line-ish". I'm sure they are great surgeons but they make A LOT of money that way.

Well, I've said my peace. I'll get off my soap box and let someone else have a turn.

[Disney 20]

I know you're just thinking and writing, not really filtering. I can accept that. I do have a couple of things to say though.

1. Most people I know can't afford to pay out of pocket for trip to Mexico for surgery which is paid for out of pocket. Insurance is the only way to get this paid for and if that's what it takes, I'll kiss their butts and make them a sandwich.

2. I wouldn't want my surgeon so far away. I want access for follow up.

3. Most of the posts and video's I've seen from people who go to Mexico say how easy it is. This scares me. It seems very "assembly line-ish". I'm sure they are great surgeons but they make A LOT of money that way.

Well, I've said my peace. I'll get off my soap box and let someone else have a turn.

You say "easy" like it's a bad thing. I had all the pre-op workups that my friend had in the states (except for the psych eval) the only difference was that I had them all in one day. Easy? Yes, just the way it should be. "Assembly line-ish"? No. I had more attention paid to me than with any other surgery I have had in the states. And by two doctors, I might add. They also required me to stay in the hospital for 4 days. They wisk you outta the hospital in much less time in the states. At least from what I've read. My friend only stayed 2 days and I have seen where some stayed only overnight. That may be fine for some, but I personally was happy to be monitored that long.

Surely you are not suggesting that the surgeons in the states DON'T make "A LOT" of money doing this surgery, are you?

[KinkySlinky 3]

I was actually told that if I go to the surgeon I have now that it is like an assembly line.. FINE WITH ME!!! The most important thing is surgical skill... Not bedside manner lol.. Assembly line-ish is actually kinda good when it comes to these types of procedures... Most experience, everything is in order, less likely for complications..

[Disney 20]

I was actually told that if I go to the surgeon I have now that it is like an assembly line.. FINE WITH ME!!! The most important thing is surgical skill... Not bedside manner lol.. Assembly line-ish is actually kinda good when it comes to these types of procedures... Most experience, everything is in order, less likely for complications..

I agree that the most important thing is surgical skill. That's why I chose Dr. Aceves. His excellent bedside manner is just icing on the cake.

Assembly line-ish is not great, though, when it comes to relating to your patient and taking care of concerns after the surgery. That is the part that's important when you have questions afterwards. I mean, the surgery itself lasts less than an hour, it's the long haul after that you need your surgeon to be there for you

[KinkySlinky 3]

Right... but a surgeon is just that.. A surgeon... His main goal is to perform the surgery, and do it well... A surgeon is not there to cuddle you after your done with the surgery.. My surgeon has several other staff members that help out post op.. We get the work email address of the nutritionist, which I *really* like because I am sure I will have a ton of questions afterwards... But as far as for this surgery, as an RN, I am perfectly content with an assembly line approach, which is also why I see a surgeon as a surgeon and nothing more... I like the lower risk of complications... Each person is different in their preference, but this is my take on the 'assembly line' approach

[Disney 20]

Right... but a surgeon is just that.. A surgeon... His main goal is to perform the surgery, and do it well... A surgeon is not there to cuddle you after your done with the surgery.. My surgeon has several other staff members that help out post op.. We get the work email address of the nutritionist, which I *really* like because I am sure I will have a ton of questions afterwards... But as far as for this surgery, as an RN, I am perfectly content with an assembly line approach, which is also why I see a surgeon as a surgeon and nothing more... I like the lower risk of complications... Each person is different in their preference, but this is my take on the 'assembly line' approach

I like the lower risk of complications, also. I think we all do, right? But I do like hearing answers to my questions from my surgeon's mouth, not other staff members. I mean, you're right, the surgeon is the surgeon, and knows a bit more than they. I agree, we are all different, and I, as a nurse also, do not like my surgeon to be unapproachable. I've worked with both types, and hands down, patients appreciate the care and concern from their surgeon in addition to an excellent operation. I really don't think taking time with your patients is a form of cuddling

Good luck to you!