Researching Mexican Lap-Band Surgeons 101

WASaBubbleButt · October 22, 2007

I make no secret of the fact that I did a LOT of research on a great deal of Mexican (and American) surgeons before making a decision on my own surgery and I think that because of that I receive a number of private messages asking how to research these surgeons. I researched the dirt and the good information on all the docs I was considering. I had a bit of an advantage as I volunteer in Nogales, Mexico for a trauma surgeon. He helped me to a great deal of my own research and he was able to find out things I might not have known how to find myself. He taught me quite a bit about researching Mexican surgeons.

I decided to start a thread that will give some starting points on researching surgeons. I'm not saying my way is the best way, I am saying this is how I did it. I have learned a few things along the way so I'm going to post this for newbies considering surgery in Mexico.

The first post will be an explanation of what I was looking for and why. The next post will be a checklist you can print out and use as you call various surgeons if you wish. It will help you organize the information because I promise you the more information you receive, the more confusing it will all be. You will go on information overload.

RESEARCHING MEXICAN SURGEONS 101

Surgery in Mexico is handled a bit different from the US. 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” banding procedure. He pays all the other surgeons.

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. 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 people. 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.

Which surgeon?

Avoid choosing a doctor that nobody has heard of before. There is little need to do that. Why take the risk? Surgeons throughout the world have discovered that banding is easy and it has the potential to be extremely profitable. Many physicians are getting in the business, so there are a lot of inexperienced surgeons around. You really want someone that is very experienced. After a bariatric surgeon has done around 250 bands 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 during fills, etc. So you want to find someone that has done at least 250 bands.

Now, does that mean that someone who has done 3000 bands is better than someone that has done 500 bands? No, not really. Think about it, were you any better at washing dishes the 500th time you did the task vs. the 3000th time? Probably not. Either you get it or you don't. The same concept applies here.

Experience

How long has your doctor been doing bands? No, not how long he has been doing bariatric surgery but how long he’s been doing bands? That is the question you want to ask. Someone can do 4000 lap procedures but that does not mean he has done 4000 bands. A doctor can do 4000 lap procedures and they might all be gastric bypass or removing someones gallbladder. That is not what we are looking for; we are looking for someone very experienced in banding issues. We have different needs and requirements than folks who had bypass and the technique is extremely different for various procedures. There is a learning curve to each procedure and with each procedure the surgeons becomes more skilled and faster at the technique. Do you want to be a part of the learning curve or do you want someone very experienced?

Skill

Skill, I think we should discuss skill a bit. Banding is the easiest surgical bariatric procedure to do. Yes, there is a learning curve but after the learning curve it is without a doubt the easiest procedure to do. That is why so many new surgeons what a piece of the action.

Can your potential doctor do the hard stuff too? Can they do gastric bypass? Gastric sleeves? Duodenal switch (DS)? Can they do revisions such as bypass to banding? Many bypass procedures fail and the patient regains their weight. Banding them is not easy at all. Revisions are difficult. Would you rather have a surgeon that only does the easiest surgical bariatric procedure? Banding? Or do you want a doctor that is capable of doing the difficult and tricky procedures as well as banding? MOST surgeons do not do all the tricky procedures, they just don't have the training, skill, or experience so they stick with the more simple procedure, banding. My personal preference is to have someone that can do it all, even the hard and tricky procedures. Some don't care, they just want a band and they are sure it will be okay. If you want a doctor that can do it all then ask about other procedures. Don't ask IF they can do the tricky and complicated procedures; ask how many they have done.

This brings up another issue. How many bands has a doctor really done? I know of two off the top of my head that have done less than 200 bands but one claims over 1000 bands on his website and another claims over 2000 on his website. Surgeons are people like everyone else and some of them are less than honest. They know that if a patient is researching they are looking for someone experienced. If they told the truth that they have done less than 200 bands they know full well nobody will go to them. So they inflate the numbers so they appear far more experienced than they are. This is not just Mexico; this is with the US and other countries as well.

One doctor combines his stats with that of another. He has done about 100 bands yet his partner has done over 1000 bands so he claims he has done 1200 bands. It simply isn't true.

So read the boards, see the patients that are posting. If someone has done 2000 bands they are going to have patients posting. If they don't, question the numbers.

Patient Coordinators

If you post that you are looking for a band surgeon the patient coordinators are going to come out posting non stop. These are people that are paid to get you to go to their employer. Some of them have been banded and some have not. They will tell you anything you want to hear to talk you into going to their doctor as they usually get anywhere from $300 to $500 for referring you. I am not downing patient coordinators in general. The people I do not like are the people that lie about it. They do not tell you they are making a commission off of your surgery and that is the prime reason they are pushing you to go to one doctor and one only.

If you suspect someone is a patient coordinator do a search of their posts. If the majority of them are pushing a specific doctor vs. giving general advice and thoughts on a topic, it is probably a coordinator. We even caught one coordinator coming up with various screen names so that people would think her doctor has more patients than he does. When people disagree with her she comes up with a new identity, pretends she is another patient, and posts. People think this doctor has more patients and bottom line, he does not.

Believe NOTHING on line. Believe NOTHING that anyone tells you. Verify everything for yourself. I do not care who tells you something, verify the information for yourself. Verify the doctor's credentials, location, years of experience, number of ACTUAL bands, everything. Ask the doctor how many of each brand of band he has placed and then call the band manufacturer and ask if they have actually sold that many bands to that given doctor. One doctor claims to have done 2500 Inamed bands but Inamed disagrees. They have sold him well under 500 bands. One needs to be certified to purchase bands from Inamed. The only place surgeons and hospitals can obtain bands is directly through the company.

Booking Agencies

This is another area of consideration. Do you want to deal with a booking agency? Some do, some don't. It comes down to personal preference. Booking agencies are paid to advertise for several surgeons, they contact the potential patients, they schedule surgery, and they let the doctor know who is coming, for what procedure, and when. They deal with all the issues before and after surgery. Do you want to deal with a booking agency or do you want to deal with the doctor's office directly? Again, there is no right or wrong answer, it is personal preference. Personally, I want to deal directly with my doctor's office. I don't want to deal with a booking agency, some are quite good, and some are not. Just make sure you are dealing with a quality agency.

Where in Mexico?

Now you need to think about if you want surgery near the border or deeper into Mexico. This is something that is purely preference. Some people want to make a mini vacation out of their surgical trip and others do not. Some want to go to Monterrey for a few days ahead of surgery and have a little fun. Others (like me) want to be close to the border. If something happened I wanted to be close to the US. Again, it is a matter of personal preference.

Hospital or clinic?

This is another issue of personal preference. Some people do not mind, others do. Some clinics are absolutely fine and perfectly safe and clean. I preferred a hospital vs. a clinic and the reason is potential complications. Let's be realistic, we are fat. Fat people carry more risk for complications such as heart problems, throwing blood clots, etc. If you have a serious complication in a clinic you will need to be transported to a hospital. Life in Mexico is not like life in the US. In the US if you have a problem in a US surgical center they dial 911 and you are at a hospital within minutes. That is not the case in Mexico. Yes, they do have emergency services but it is not similar to the US. They will get to you when they can. That is not immediate. For that reason I personally preferred a hospital. The risk for banding complications is quite low but it does happen. If it did happen I wanted to already be in a hospital.

Price

What about price? Many make the mistake of shopping by price and quite frankly there are times in life that you really do get what you pay for. Cheaper is not always better. Keep in mind that with Inamed and Johnson & Johnson bands the cost to the doctor is $2000 per band. That's what the surgeons in Mexico pay for the band. If the doctor is really cheap he is cutting corners somewhere or... he is so bad that the only patients he gets are people shopping for price vs. surgeon skill. There is also little need to go to the most expensive doctor. Expensive does not mean skilled, it means expensive.

Patient Testimonials

Patient testimonials are critical to read. Go to LapBandTalk and research your doctor.

Talking to people on line is a great way to get an idea of surgeons. But talking to a few people and feeling that they did well during surgery and that's your research, that is just dead wrong. You need to read at least 100 patient testimonials or talk to at least 100 people about their surgery.

Do a www.LapBandTalk.com search on the name of the doctor you are looking at. Read it all. Do not ignore the bad, read it. If you have questions send the author a private message. There are two surgeons I can think of that have the absolute worst reputations in Mexico yet people are unwilling to take the time to do a search on their doctor and they are surprised after they announce they are going to Dr. "X" and people are shocked. People will try to warn them and tell them they are not going to a skilled surgeon but they refuse to listen and it is typically price that formed their decision or they really "like" a poster and that poster went to Dr. "X". Some people are simply sick of researching so even when they realize they did not choose the best physician for them, they go anyway. Others are desperate for a band and they no longer care about skill level. Be very careful and do the research.

I know of one person that had two friends that went to a specific doctor and that was her research. That's it, that is all she did. She went to the same doctor and ended up with an infection so severe she will lose her band. Actually, she probably already has lost it at this point. She also went to one of the two worst surgeons in Mexico. It happens all the time and it is not just Mexican surgeons that cause infections, it happens in the US. You are not going to all the expense and trouble to be banded just to lose your band (and potentially your life) to a crappy surgeon. Do your research.

People make huge claims here about their surgeons and they simply are not true. "My surgeon is a LEADING" surgeon in banding." Well, what does that mean exactly? What is a leading surgeon? "My surgeon is a TOP banding surgeon." Says who? Who makes these claims? I'll tell you who makes them; the surgeons make the claims about themselves. I can say I am a "LEADING" nurse, does that mean anything? Does it make it true?

Pre-Op Testing

This is critical to have a safe surgery. You should get AT LEAST a complete blood count, chemistry panel, urine test, EKG, and chest x-ray. Do not settle for anything less. If the doctor does less testing than this he is pinching pennies in all the wrong places. This is your health, you are paying for these tests, make sure you get them. I know of one doctor that claims he does an EKG during surgery. That is NOT an EKG! That is a heart monitor and it does not have the same information as a full EKG. Besides, one of the issues they are looking for during surgery on the heart monitor is if there are any heart changes due to the anesthesia. If you didn't have an EKG before surgery how will they know if there are changes due to anesthesia? If you don not get these tests that you are paying for, the money is just going in your doctor's pocket instead of your health care. You are the consumer here, insist on the appropriate testing. Do you want your money for banding going towards your health care or your doctor’s new swimming pool? Bariatric surgeons are not typically hurting for money. They are being paid to do ALL the tests, get them done.

Post-Op Testing

This should be a barium swallow that is done after surgery. One doctor's office claims they cannot do a barium swallow after surgery because the barium is too thick. This is simply untrue. Barium comes in a powder form and it can be made as thin or as thick as needed. It can be watery or it can be very thick. The only reason for not doing a post op barium swallow is to save the doctor money. Again, this is a procedure you pay for, make sure you get it.

You want a barium swallow after surgery for various reasons. Example: What if you get home and have some sort of complication? You are going to have to have it done anyway and at home you'll be paying full price and your insurance is not likely to cover it. Considering you already paid for it in your surgery package you should have had it. You should be given the films to take home with you after this test when done in Mexico along with all your labs, EKG, etc.

You also want this test to make sure you are safe to travel back to the US. A barium swallow makes sure that band placement is correct, Fluid is traveling through your stoma, and there are no unexpected medical problems. It also does a great deal for you as a patient. When you can actually see the band and see the band working with your own two eyes, this makes a world of difference. It puts things in perspective for you as a patient.

What if you go for your first fill and your fill doc does not use fluoro? It is nice for him to see the films so that he can see where your port is and believe me, that makes it easier for you while he is looking for your port.

So there are many reasons to get the barium swallow after surgery. If your potential doc does not offer this important test, find a new doctor. You are paying for it, so get it.

Nude/Semi Nude Photos

Some surgeons 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, 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 when it comes to these kinds of photos.

Supervision

Regardless if you have surgery in a hospital or clinic you should have a certain amount of medical supervision. If you are in a hospital you will have that. If you are in a clinic you will have it. 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 surgeons 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.

Pre-Op Diets

It is common for surgeons to put patients on a pre-op diet before surgery. Many still say it is to shrink the liver, but that isn't quite true. The reality is that if someone is on a low-carb, low-fat, 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 and secure the band around it. If it is slippery and difficult to manage, it makes it more dangerous for you, so the pre op diet is indeed quite important. Studies show that the liver does not actually start to shrink in size until you have been on such a diet for about six weeks or longer. Again, it is still quite important to follow the diet for your safety. Some surgeons do not require the diet because it does not actually "shrink" the liver. Others do. It comes down to surgeon preference. Some surgeons 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. But that is a post for another day. Find out what your doctor's post-op diet is, make sure you understand it well, and if you do not then ask questions.

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 will return phone calls and emails much faster than they will 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.

Statistics

You should ask your potential doctor's office about his stats for infection, slips, and erosion. 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 PEE 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.

I am of the opinion that most slips (not all) but most are the fault of the patient. Not eating the right foods, not chewing well enough and PBing, etc. Global slip stats according to Inamed are around 3% so your doc's slip stats should be less than 3%.

The latest thinking is that erosion is from a band that is too tight. That can be a band that was too small for the patient at the time of surgery or the patient got a fill that was too tight and they did nothing about it. Global erosion stats according to Inamed are 1.3%, so your doc should be well under 1.3% for erosion stats.

There is one doctor who has a 4% erosion stat. When it came out on the boards that this is a concerning number they changed the way they word things. Instead of saying >1% infection, >2% slips, and >4% erosion he now combines ALL stats and says that his stats are less than 3%. He's just averaging them out to avoid the truth of the 4% erosion figure. An overall complication of about 3% doesn't sound NEARLY as bad as 4% erosion. But do people pay attention to these things? NO! They don't. So be very careful to ask for each individual statistic.

There is another trick to watch for. Ask your potential surgeon how many bands he has placed. Then ask if his stats for infection, erosion, and slips are the figures for 100% of his bands placed or if they are for a smaller number. If a doctor has a given statistic of 4% for slips, erosion, or infection but he will only provide you with the statistics from a given group or given study, those are not true figures.

For example, if a doctor claims to have done 1000 bands but claims an erosion statistic of >1% for the last 300 of those bands, why isn’t he telling you his true erosion statistics for all 1000 bands? They get tricky and you have to see what they are doing. They are being honest in the sense that they are telling you their statistics but only the good statistics. They are hiding the bad (and more accurate) numbers from you. This is another reason you need to research and this applies to US surgeons as well as Mexican or any other country.

If they are a good doctor with a proven track record there is little reason to be deceptive, play games, and hide facts as their reputation and background should speak for itself. But do stop and think about it, if they are attempting to hide figures from you - they are doing this knowing full well their deception. Is this the surgeon you want to trust your health care and your life?

If you contact them again and the give you three pages of nonsense that still does not answer your specific questions, they are attempting to talk around your questions. No good physician will attempt this. They will just bloody well give you the numbers you have requested. If it is like pulling teeth to get the actual numbers, walk away. Find someone a little more honest.

Which band will you receive?

There are currently two brands of bands FDA approved in the US. Inamed and J&J. J&J was only recently approved for use in the United States, and many US surgeons may not have experience with them. Remember this when you are arranging aftercare. It will be hard to obtain a fill for bands other than these two brands, as a US doctor can have problems with the licensing board if he works with a non-FDA approved device. Take this into consideration. If you get an Inamed brand band you should be given the empty box, an instruction book, and an ID card showing the size and type of band you have. If you get a J&J band you should receive the empty box, two booklets, and an ID card. You may need these items to prove to a US doctor that you have an FDA approved device so they can do your fills. Not all surgeons require you to show them the box and information but some do.

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.

Finding a Fill Doctor

Make sure you an find a doctor within driving distance of you before heading to Mexico for surgery. Some live close enough to the border to drive there, for others it is an inexpensive flight for fills. Regardless, you need to work out a fill person BEFORE having surgery in Mexico.

WASaBubbleButt · October 22, 2007

CHECKLIST FOR CALLING SURGEONS IN MEXICO

Print one copy for each MD office you call to compare what each surgeon has to offer.

Surgeon’s Name:
City:
Distance from US border:
Coordinator:
Dealing with surgeon’s office or booking agency?
Agency name (if booking agency is used):
Does the doctor have his own email list/message board for his patients?
If so, what is the address?
Total fees:
Are fills included?
If fills are included, how many and for how long?
Airport you will be flying to?
Is transportation included?
If included, what kind of transportation is it?
Who answers the phone during off business hours? (Call in the middle of the night to verify this.)
Will I need to do a pre op diet?
If so, what does it consist of?
Will I need to do a post-op diet?
If so, what does it consist of?
Is surgery performed in a hospital or clinic?
Will I stay in a hotel the night before surgery?
Is the price of the hotel included?
How many hours will I be in the hospital/clinic after surgery?
Will I go to a hotel after surgery?
Is that price included?
If I go to a hotel after surgery, how long will I be there?
How many visits from the surgeon or nurse will I receive after surgery?
Specifically, which pre-op testing will be done? (Testing should be done before surgery, not during, and should include the following tests: CBC, chem. panel, UA, chest x-ray, and EKG.)

Specifically, what post-op testing will be done? (Should be at least a barium swallow. A US facility cannot be a Center of Excellence without this test after surgery, and it is considered routine for most doctors.)

Will I be given all my pre-op and post-op test results to take home to give to my doctor? (Should be surgical report, band serial number, all labs, EKG, and films from barium swallow.)

Does the surgeon open me, place the band, and close me, or does the assistant surgeon do most of this? Will my surgeon be in the operating room during the entire procedure?

Is all staff in the operating room licensed?
How many licensed doctors?
How many licensed nurses?
How long has the doctor been placing bands? (Not performing bariatric surgery, RNY, or laparoscopic procedures, but actual bands.)

What brands does the surgeon use?
Is the doctor Inamed or Johnson & Johnson certified?
Is the doctor certified in bariatric surgery in Mexico? (You MUST verify this, do not rely on their response.)

How many bands has the doctor placed as the lead surgeon? (If this is an unknown number that usually means the stats are combined with someone else’s or he was the assistant surgeon and stood there while the actual surgeon placed the bands.)

How many bands of each brand has the surgeon placed? (If the doctor claims they have placed 2500 Inamed bands yet have only purchased 200 bands from Inamed, you know they are inflating their statistics.)

Statistics: (Don't let them combine stats for a total "complication" figure as that artificially lowers one of the stats and means they are hiding something. Demand specific numbers for each complication.)

- What are their infection statistics? (Should be less than 1%.)

- What are their slip statistics? (Should be less than 3%.)

- What are their erosion statistics? (Should be less than 1.3%.)

How many Gastric Bypass procedures has the doctor done? (Goes to show skill level with tricky procedures.)

How many Gastric Sleeve procedures has the doctor done? (Again, shows skill level with tricky procedures.)

How many revisions from bypass to band has the doctor done? (Again, shows skill level with tricky procedures.)

WASaBubbleButt · October 22, 2007

BTW, this thread is not designed for folks to tell how great their doc is/was/will be. This is meant to be an objective and neutral method for people to do their own research. Thanks!

However, this does bring up the topic of patient coordinators. I'm going to copy/paste something from another thread regarding coordinators. They post on every obesity board a great deal and try to get you to go to their doctor. Sometimes they are banded and sometimes they pose as a banded patient that just loves their doc. They are paid a commission to try and get you to go to their doctor. You just don't know that because they don't tell you.

They don't care if you go to a quality surgeon, they care about getting a commission from your referral to their doctor. This is why I can't stand them and I wanted just ONE thread free of clutter about how much someone likes their doctor.

Patient coordinators do things such as:

~Start threads about their doc and do anything to keep it going even if it means posting about the weather just to keep it bumped to the top.

~As soon as the least bit negative fact is written about their doc they cry, scream, stomp their feeties, claim their thread is ruined so they start a new one so the newbies won't see the facts. They claim the factual information is "poison" and it really gets them in a huff. It's amusing to watch.

~They create new IDs and come back trashing the "good" docs. We caught one of them doing it so she came back with ALLLLL new IDs.

~They don't admit there is the least little thing negative about their doc.

~They make it a point to post their email address so you can email them personally and get more info. That way they have more reason to talk to you in detail and provide you with a website address.

~They are sure not to say anything positive about another doc. You will never see them saying "Dr. X is as good as my doctor." No other doctor is as good as theirs.

~When they create new IDs and trash other docs they run around reposting the link to other threads to make sure everyone sees someone trashing another doc. It's a great scare technique for newbies.

~They create lots of IDs to pretend like they are happy patients. In reality, there are few people posting but many many IDs.

~They don't push independent research, they'll do your research for you. (That's key)

~Many of the newbie (fake) IDs gravitate back to a single doc. After they post an untrue story about one doc they change IDs, respond their original "trashing" post, and proclaim THEY aren't going to THAT doc, they are going to the other doc, the "better" doc.

~They hide facts and stats about their own doc. Their idea of a "good" surgeon is someone that was nice to them. Nice does NOT mean SKILLED. They will talk about how they felt like family, they were treated sooo well, they were not afraid in Mexico at all, they act as though surgery was actually a party. My neighbor is nice, doesn't mean I'd want him to operate on me. Why not post the facts? The experience? (True experience, not inflated numbers to make someone look more experienced than they are) The stats? The affiliations? Instead, they talk about how nice he is.

~They assume their doc is best for you. Their doc may not be best for you, no single doc is the best for the whole world. People have different needs, they have different preferences, they prefer different locations. But they will ALWAYS push THEIR doc and only their doc. Do you advertise for your doc or do you assume he can do his own advertising? I mean, did you pay your doc many thousands of dollars so you could spend your time advertising for him? Or is he the one that needs to provide services that you paid for? The only reason to advertise for a doc and post non stop about him is to earn a kickback.

~They will average stats vs. pointing out individual stats to hide a bad one. Instead of saying x% slips, x% erosion, x% infection they will average them all out to a single number to hide one of the stats that look bad because it IS bad.

~They jump into threads and comment about how wonderful their doc is. I mean, if I am asked I will tell people what they want to know about my doc but I don't run from thread to thread explaining he's soooo nice and a "leading" surgeon. Again, my MD can do his own advertising.

I have seen something since before I was banded. Newbies... they are absolutely in love with their doctor. They have had a huge problem (obesity) for a very long time and they have been frustrated, humiliated, embarrassed, annoyed, and angry that they couldn't manage to fix it on their own. Right after surgery they finally see a light at the end of the tunnel and they know their doc was able to fix this for them. They are dearly indebted and in love with their doc. With time they get beyond the honeymoon stage and realize that we all have the same problem and all our docs did the same thing for us. Surgery. They aren't Gods and they simply know how to wrap a band around your stomach. That's all. With time they figure this out.

I have no problem with the usual patient coordinators, I don't like the liars who either pretend to be banded when they aren't so they can sell an MD and make $$ or they are indeed patients and they get a fee for referring others to their physician. There is a place for patient coordinators, that SHOULD be in an office answering questions and telling you the truth, their job is to sell a given physician. If their physician is any good they should be able to list off all the facts, stats, experience, etc. about that person vs. trashing every single other doctor to make theirs look good. If someone does get a fee for referring people to their doc, shouldn't they be honest about that? Why hide it?

Don't misunderstand, I now have a few Mexican doctors on my list of "evil" that I wouldn't send my worst enemy to. But that leaves the majority that are good, caring, skilled, and experienced physicians that people should go to if they so desire.

Why not show people how to do their own research? What's the horror in that? There are MANY MANY (majority) good Mexican docs. So why only push one? Why not show people how to avoid the bad doctors vs. only going to one doctor? The really bad ones are the minority.

There is one doctor with a 4% erosion statistic. There are two docs known for sending people home with life threatening infections. They have also been known to place bands incorrectly and upon returning to the US they have to have their bands removed. Then there is a 4th who used to make his own bands.

Shouldn't we be helping people to avoid doctors like this vs. encouraging them to go to someone who isn't all that great just because of a stupid commission?

I just get frustrated, we should be helping newbies, not lining our own pockets.

ellemay · October 22, 2007

Thanks, this is an interesting post indeed. I did some research but not nearly as much as what you have listed. I believe I went into it a bit blind.

The pre-op and post-op diets and reasons are interesting. When you get a chance please post your thoughts on the theory behind the post-op diet.

Many people here are just newly banded and like me can eat solids now and are doing so. I'm trying to be good but when you are hungry all the time you give up. I'm currently waiting for my first fill before I take it more seriously. Wrong I know, but if I had willpower maybe I wouldn't have needed the band!

Cheers

WASaBubbleButt · October 22, 2007

Thanks, this is an interesting post indeed. I did some research but not nearly as much as what you have listed. I believe I went into it a bit blind.
The pre-op and post-op diets and reasons are interesting. When you get a chance please post your thoughts on the theory behind the post-op diet.

Many people here are just newly banded and like me can eat solids now and are doing so. I'm trying to be good but when you are hungry all the time you give up. I'm currently waiting for my first fill before I take it more seriously. Wrong I know, but if I had willpower maybe I wouldn't have needed the band!

Cheers

I cheated and copied this from another post I wrote.

Following Post Op Diet:

When you eat food your stomach has to churn and work to break food down so it can pass through the GI system. When you drink Clear liquids it virtually does little to no work. When you drink full liquids it doesn't have to work hard. When you eat solids your stomach has to work very hard to break down food while it mixes with stomach acids. It almost looks like stomach spasms.

Since it is the scarring and adhesions that hold the band in place and not the sutures (long term), when you eat solids your stomach is moving and churning and this prevents adhesions from forming.

The other issue is that when they first started doing this procedure they made the pouch bigger than they do now. People were not losing weight with a larger pouch so they started making it much smaller. If you eat solids before you are supposed to you can actually push your pouch down and the adhesions that do form will secure the pouch in place but with a much larger size. You could end up with a larger pouch and weight loss will be very difficult. The only repair is surgical and then you start the post op diet all over again. I doubt most docs would redo the procedure because you didn't follow the post op diet.

When you don't follow your doc's instructions you are only harming yourself. If you want the band to work, you have to do as your doc tells you.

I think there should be a huge warning label somewhere that patients have to read before surgery. If you want your band to work you have to follow the instructions for EVERYTHING and especially a post-op diet.

When you are doing clears/full liquids/soft foods remember that sugar, ANY kind of sugar or carbs will make you want to eat your right arm. Protein will kill hunger. It's the way your blood sugar and pancreas work. When you eat sugar your blood sugar increases. Then your pancreas kicks out insulin, then your blood sugar decreases and that sends hormones that tell your brain you are hungry again. When you consume Protein it doesn't mess with your blood sugar much so your body isn't constantly trying to tell your brain you are hungry. Oh, you'll still have head hunger issues, but we all have that and that is a big reason we are fat. But mix head hunger with stomach hunger and we will fail. It's just too much.

So cut out ALL sugar and most carbs, limit carbs to 30gms daily. Then bump up your protein and that should make it so you can manage post op diets.

ellemay · October 22, 2007

Thanks, I think I had better go back to Liquids for a while!

I like to know the scientific reason for doing it. The reason I stuck to the pre-op diet was because they said it make surgery easier and safer.

It was not mentioned that if I didn't stick to the post-op I could stretch the pouch etc... This makes sense and perhaps it will be easier to handle now. I'll put up with the head hunger for a while if it will benefit the outcome longterm.

This has been very helpful to me.

need to lose · October 22, 2007

Thank you so much "I was a bubble butt"! Your research and time on this website is really helping me make a decision. My husband and I are going to meet Dr Aceves in a few weeks. I finally convinced him to just take a drive! Take care and trust me, your posts are really apprectiated.

jennypoo · October 22, 2007

Thanks Wasa!!!

For all the info and guidance you have done with/for me.I think I pretty much have done all of the above.Well except the banding itself and that is approaching very soon!!!And Im ready:)

Cant wait!!!

Jennifer

TheFox · October 23, 2007

Very, very informative post. I think it deserves a sticky.

anonemouse · October 23, 2007

Very, very informative post. I think it deserves a sticky.

I agree. All of this goes for US doctors, too. I wish I had had this when I was first looking into surgeons. In my case, though, I didn't have a lot of choice of who to pick, because my insurance plan only covered two bariatric surgeons in the entire state of Tennessee. And I REALLY wish I had paid attention to the post-op diet posts before I had surgery. I was literally eating well-chewed soft solid food two days after I had surgery. (I love my surgeon to death, but she didn't place too much importance on the post-op diet, apparently, since she directed me to start eating solids as soon as I started feeling hungry.) At this point, all I can do is hope I didn't do any damage to my band.

WASaBubbleButt · October 23, 2007

I agree. All of this goes for US doctors, too. I wish I had had this when I was first looking into surgeons. In my case, though, I didn't have a lot of choice of who to pick, because my insurance plan only covered two bariatric surgeons in the entire state of Tennessee. And I REALLY wish I had paid attention to the post-op diet posts before I had surgery. I was literally eating well-chewed soft solid food two days after I had surgery. (I love my surgeon to death, but she didn't place too much importance on the post-op diet, apparently, since she directed me to start eating solids as soon as I started feeling hungry.) At this point, all I can do is hope I didn't do any damage to my band.

JFTR...

Lauren deserves half the credit for the time and effort into the first two posts. She did all the editing because we ALL know how well *I* spell and how great my grammar is.

Thanks, Lauren!

WASaBubbleButt · October 23, 2007

Very, very informative post. I think it deserves a sticky.

I just want people to do their research. There is soooooo much to research and much to know. Going to Mexico can potentially be better than the US for banding but you just have to know what to do and how to do it.

I want to do another one on how to verify credentials, Mexican Gov't links, etc. I'm working on it.

Lauren, up for more editing and formatting?

anonemouse · October 23, 2007

I just want people to do their research. There is soooooo much to research and much to know. Going to Mexico can potentially be better than the US for banding but you just have to know what to do and how to do it.
I want to do another one on how to verify credentials, Mexican Gov't links, etc. I'm working on it.

Lauren, up for more editing and formatting?

Always! And here's an emoticon, because the message was too short! :clap2:

anonemouse · October 23, 2007

JFTR...
Lauren deserves half the credit for the time and effort into the first two posts. She did all the editing because we ALL know how well *I* spell and how great my grammar is.

Thanks, Lauren!

You are very welcome!

faithmd · October 23, 2007

This is a great thread you two.

And just an FYI for you, Lauren: At the ASBS convention this past June (when they released the AP band) there was a presentation about the post-op diet and guidelines for revision to allow softs to solids much earlier than before. I notice that Allergan hasn't changed their reccs on their website yet, but I found it interesting that someone would present to a group of bariatric surgeons that it is okay to eat earlier. Perhaps your doc had read the latest from the convention and that is what made her put less emphasis on the post-op diet.

I have to wonder though if part of the reason for the change in diet comes from patients complaining and griping about being hungry so much. And/or if the change was intended for AP band patients only.

But thinking logically about the stomach and it's action to digest, I can't imagine that speeding up the post-op diet would be fine and dandy. But I'm not a surgeon and I'm not a bariatric researcher. Of course, one can always go slower on their post-op stages themselves.