P.a. & Surgeon Against Me Getting The Sleeve

[TamaraS 235]

Thanks and best of luck to you LadyK, I hope we can keep up with each others process

[Sassy Sleever ~ RoseLee 1]

I'm 5'4" at 300lbs now lost 38lbs so far and my BMI is 52 I don't really like the doctor doing my surgery cause he never has time for me to ask question's but he has never tried to talk me out of having the sleeve and I'm going to be having my surgery on October 17th And I told my doctor from the get go I want the sleeve also u may want to get a new doctor before u have surgery cuz by them pushing u so hard to get the bypass it seems to me he may need up giving u an unwanted bypass

[TamaraS 235]

Thats frustrating SassySleever, I wont even meet my surgeon until right before surgery. That doesnt seem normal? but I dont know. I do know they are busy because him and his partner have done over 6,000 weightloss surgery procedures combined. I guess thats why he has P.A.'s do everything!

[isajck 229]

Please explain not meeting the surgeon until right before surgery. Did he not have a consultation with you when this whole thing started? Who decided that you even qualified for the procedure? Please tell me it wasn't a PA! Why I have nothing against PA's, for some reason I think a surgeon should be involved in your care before the pre-op visit!

Personally there is no way I'd be involved with a surgeon so busy that I could not meet him until right before surgery. That is a warning sign to me.

[TamaraS 235]

It does seem strange but I did all of my preop with PA's at his office. I originally asked my dr. about the surgery and based on my Insurance he sent me to this office. They are the only ones near me that accept my insurance. Sigh, Im really really glad he does this surgery so often because the more I find out from others the more I see discrepincies in my experience...

[RickM 1,747]

If they are strongly trying to push you towards a bypass and stating the doctor will as well maybe it's a offhand way of saying he is not competent in this particular procedure.

I would start looking for a new doctor, seriously. Your life is worth it. The insurance company will not care if they are contracted. It may cause a slight delay while they adjust the approval to cover the new physician and/or facility but it is doable.

I have been wondering things along the same lines - maybe within their experience in their practice, they don't have such good success with the sleeve with higher BMI patients. I would take their advice seriously, which leaves you with the choice of having an RNY with them, or going elsewhere for a VSG (which would certainly be my preference - I never seriously considered the RNY or bands.) There are other surgeons who have had good success with the sleeve and higher BMI patients, though you may have to travel a little farther than you had planned - SF seems to be attract top-drawer bariatric surgeons. Though I'm not a big fan, Dr Cirangle seems to have developed his sleeves and program to work very well with higher BMI patients; Rabkin and Jossart are both well experienced and capable DS and sleeve surgeons there as well. There is also Dr. Keshisian, who operates out of both Delano and Glendale, and is another top flight DS and sleeve surgeon.

While with the excitement, stress and hassles involved in getting this close to surgery, it may be well worth taking a step back and re-evaluating things as either an RNY or a substandard sleeve could lead to substantial disappointments down the road, possibly taking you down the path of a revision that may never had been necessary had the correct surgery been done in first place (and if you need to revise an RNY, then you will probably be going to either Drs. Rabkin or Keshisian, as they are two of maybe a half dozen surgeons in the US and Canada who are actually qualified to revise an RNY to a DS. Further, at your BMI, it is worth researching and considering the DS (if you haven't done so already) along with the VSG as it does classically work better for high BMI patients, and has better regain resistance than the other mainstream WLS procedures if regain or yo yo dieting has been in your past history.

Good luck in your journey, whatever decision you make,

[TamaraS 235]

Thanks for all the information Rick, I appreciate it!

[valdostaGA 149]

Sounds like you're on the wrong team! Be patient and find u another surgeon. Sound like he's insecure about doing the sleeve to me..IJS

[Need-a-Sleeve 211]

Thats frustrating SassySleever' date=' I wont even meet my surgeon until right before surgery. That doesnt seem normal? but I dont know. I do know they are busy because him and his partner have done over 6,000 weightloss surgery procedures combined. I guess thats why he has P.A.'s do everything![/quote']

This thing has red flags all over it. Sounds like this is a surgery mill & like the doctor wants to do the procedure he is most comfortable doing. For the sake of doing the prudent thing, call your insurance carrier's customer service & ask for the names of other bariatric surgeons. If you are picking a surgeon, who will have your life in his hands without even meeting him till he cuts on you, sounds like an even bigger risk. Just my two cents but after working as a RN in the OR for 18 years & now insurance for that long--I would not settle.

[Kalimomof3 613]

Sleeve used to be the first of a 2 step surgery process for patients with too highBMI for trafitional WLS with the 2nd step or second surgery being the Duodenal Switch ( some say RNY but everything I have seen says Duodenal Switch is the 2nd step) either way if you do not get the results you want from the sleeve alone you could under go the DS afterward or now RNY. The problem I have heard in my support group is that for SOME patients with high BMI the Sleeve is not restrictive enough in nature and SOME patients still make TERRIBLE eating choices bc they don't experience the dumping the way that RNY patients although some sleeve patients do experience dumping... The way the surgeons explain it is this ... Band is resrtictive meaning it only limits how much you can eat, Sleeve is mostly restrictive,RNY is both restrictive and mal absorbative meaning you can't eat much and your body doesnt absorb all that you do eat thus creating "more" weightloss but the mal absorption is what causes the Vitamin deficiency too.I have heard people at the support group say they are going to get the Sleeve bc they can still eat "normal" with it and I see that as indication that the sleeve may not work for them bc their "normal" is what got them to where they are... But any way you slice it if you don't change your head ANY WLS CAN FAIL ... I am thinking that maybe your PA or surgeon have doubt about whether or not you will comply with their assigned diet and that they feel they will have more weightloss success with RNY if your compliance is an issue but that would just be my guess.I don't want to deal with the vitamin deficiency an other problems that go along with RNY most times which is why I chose the Sleeve but I did go back and forth between RNY and Sleeve.

[Butterthebean 8,146]

The problem I have heard in my support group is that for SOME patients with high BMI the Sleeve is not restrictive enough in nature and SOME patients still make TERRIBLE eating choices bc they don't experience the dumping the way that RNY patients although some sleeve patients do experience dumping... The way the surgeons explain it is this ... Band is resrtictive meaning it only limits how much you can eat' date=' Sleeve is mostly restrictive,RNY is both restrictive and mal absorbative meaning you can't eat much and your body doesnt absorb all that you do eat thus creating "more" weightloss but the mal absorption is what causes the Vitamin deficiency too.I have heard people at the support group say they are going to get the Sleeve bc they can still eat "normal" with it and I see that as indication that the sleeve may not work for them bc their "normal" is what got them to where they are... But any way you slice it if you don't change your head ANY WLS CAN FAIL ... I am thinking that maybe your PA or surgeon have doubt about whether or not you will comply with their assigned diet and that they feel they will have more weightloss success with RNY if your compliance is an issue but that would just be my guess.[/quote']

Very very good points. I was thinking something along those same lines. They are prejudging the patient's willingness to follow the plan based on her BMI.

My wife works with MD's all day and I here about them from her all the time. They can be just as biased and narrow minded as the rest of society. Medical school certainly does not expand your mind. The problem is when a doctor says something most of the world takes it as fact, when in reality it is just as likely to be an opinion. They are just normal people with superiority complexes, not walking talking encyclopedias. They are more like walking wikipedias.

[JMarshall 352]

My doctor is the Chief Surgeon at Jewish hospital in Cincinnati and performs all three surgeries VSG ,Bypass and the Band. when i spoke to him he gave me the pros and cons to each surgery. he pushed me towards having the sleeve for three reasons. I am young, The weight loss between the sleeve and bypass are similar, i have over 200 pounds to lose and the sleeve can be revised to the bypass. Fast forward 11 months out , i am down 203 pounds overall. i have not had any complications other than dehydration 1 week after surgery. My surgeon is actually moving away from the lap band because of all the band to sleeve revision surgery's that he has had to perform.

[LessofKelly 62]

My bmi was 51. I was sleeved 2 weeks ago today. I'm already down 25lbs.

[TamaraS 235]

I only have insurance through October and then only my husband will be covered through work. I dont want to risk not being able to have surgery by shopping around. I am completely confident in him as a surgeon, he has so much experience. My issue is as Kali mentioned, Maybe he doesn’t think I can adhere to the diet and get the weight off and maybe I should listen to him. It’s easy to doubt myself because of multiple failed experiences in the past ya know? I was 100lbs over weight by 4th grade. Ive never eaten healthy for an extended period of time, so maybe that is the concern. I will have a chance to retrain myself and teach myself new eating habits without the insatiable hunger I experience all the time. I just have to have faith in myself and realize I’m capable. I’ve been able to stay on this ridiculous pre op diet so that should say something about my determination to make this process work for me. I just have to keep my head up and my eye on the goal here.

[Ready4success 380]

I only have insurance through October and then only my husband will be covered through work. I dont want to risk not being able to have surgery by shopping around. I am completely confident in him as a surgeon' date=' he has so much experience. My issue is as Kali mentioned, Maybe he doesn’t think I can adhere to the diet and get the weight off and maybe I should listen to him. It’s easy to doubt myself because of multiple failed experiences in the past ya know? I was 100lbs over weight by 4th grade. Ive never eaten healthy for an extended period of time, so maybe that is the concern. I will have a chance to retrain myself and teach myself new eating habits without the insatiable hunger I experience all the time. I just have to have faith in myself and realize I’m capable. I’ve been able to stay on this ridiculous pre op diet so that should say something about my determination to make this process work for me. I just have to keep my head up and my eye on the goal here.[/quote']

I think you should stand your ground and have the sleeve, if that's what you want. The surgeon can make you uncomfortable, but he can't make you do something you don't want to do. Tell the surgeon that you want try the least invasive surgery first, and if you can't achieve the success that you want, you'll be back for a conversion to DS. That's the great thing about the sleeve, if you don't achieve the success you want, it's not the end of the road. Yes, you can do it! Don't let them tell you that you can't.