Is my doctor qualified?

[atlast1976 1]

I am reposting this again as a new thread as its not exactly related to the first topic. Thank you so much for your replies. I am a nervous wreck thinking about all this. I have had two lapbands. The first one slipped and I needed emergency surgery (after throwing up several times a week for a year and then finally not being able to swallow my own saliva) and the second one is not providing any restriction at all, completely filled to max. I really want to convert to the sleeve. From what I have heard about it, it sounds like the best of both worlds. I have a consult on Monday. The woman who does the insurance approvals said that she just received coding for this procedure. I think that means they could bill for it now and it just needs to be approved by insurance. One big problem is that my Doctor who is a top bariatric surgeon in my area, has not done sleeves. He has, however, done many duoendum (sp) switches, the first portion of that surgery as I understand is a sleeve. So from that standpoint he actually has performed the surgery, just as part of a two part operation. He is just now beginning to bill for it as a stand alone procedure. What do you think?

[WASaBubbleButt 41]

I am reposting this again as a new thread as its not exactly related to the first topic. Thank you so much for your replies. I am a nervous wreck thinking about all this. I have had two lapbands. The first one slipped and I needed emergency surgery (after throwing up several times a week for a year and then finally not being able to swallow my own saliva) and the second one is not providing any restriction at all, completely filled to max. I really want to convert to the sleeve. From what I have heard about it, it sounds like the best of both worlds. I have a consult on Monday. The woman who does the insurance approvals said that she just received coding for this procedure. I think that means they could bill for it now and it just needs to be approved by insurance. One big problem is that my Doctor who is a top bariatric surgeon in my area, has not done sleeves. He has, however, done many duoendum (sp) switches, the first portion of that surgery as I understand is a sleeve. So from that standpoint he actually has performed the surgery, just as part of a two part operation. He is just now beginning to bill for it as a stand alone procedure. What do you think?

Sure, if he has done at least 250 DSs and 250 bypass or at least a total of 250 DS and a total of 500 staple lines he's fine.

Does he do DS by lap?

Still do your research and really know everything there is to know about him. Ask for bougie size, stats, leak tests, etc.

[circa 0]

Yeah I would think that if he has done that many DS's he's very experienced in it - Just tell him to stop before he gets to the second part :thumbup:

Talk WITH the surgeon and I'm sure he can answer your questions and calm your concerns

[MacMadame 81]

I would ask him what boughie size he's going to use. You don't want him to use the big boughies that DSers get because you'll have no malabsorption and their sleeves stretch a lot over time. Sometimes beginning sleeve surgeons are reluctant to use the smaller sizes that experienced sleeve surgeons end up moving to over time.

[Malaika 50]

I would ask him what boughie size he's going to use. You don't want him to use the big boughies that DSers get because you'll have no malabsorption and their sleeves stretch a lot over time. Sometimes beginning sleeve surgeons are reluctant to use the smaller sizes that experienced sleeve surgeons end up moving to over time.

Mac -- what is a boughie? Does anyone know what size Dr. Aceves uses? I only want to have this done once!

[Elisabethsew 50]

Mac -- what is a boughie? Does anyone know what size Dr. Aceves uses? I only want to have this done once!

It's the guide they use to size the sleeve. Dr. A. uses a 36 but he oversews the staple line (leak prevention) so it becomes a 34. The smallest is a 32 and some MDs use very large sizes.

To understand oversewing, think of hemming a skirt. You fold over the fabric and sew. After stapling the suture line, Dr. A. folds over part of the stomach and sews it. That makes the 36 boughie the size of a 34.

[Malaika 50]

It's the guide they use to size the sleeve. Dr. A. uses a 36 but he oversews the staple line (leak prevention) so it becomes a 34. The smallest is a 32 and some MDs use very large sizes.

To understand oversewing, think of hemming a skirt. You fold over the fabric and sew. After stapling the suture line, Dr. A. folds over part of the stomach and sews it. That makes the 36 boughie the size of a 34.

Thank you - that makes perfect sense to me now.

[Ruthi 60]

It is so wonderful to have such knowledgable people like Elizabeth and Wassa to answer questions like that, thanks to both of you

[Elisabethsew 50]

It is so wonderful to have such knowledgable people like Elizabeth and Wassa to answer questions like that, thanks to both of you

WASA was who I "used" to hook me up with a good surgeon. Since she and I are both RNs, we tend to be on the same page about many things. LOL.

[WASaBubbleButt 41]

WASA was who I "used" to hook me up with a good surgeon. Since she and I are both RNs, we tend to be on the same page about many things. LOL.

Very true! And through this we have become friends as well... nothing like those 3.5 hour conversations on the phone! HA!

[Ruthi 60]

We wont hold that against you; we are still grateful for your advice and input

[DownInSocal 12]

How do you pronounce boughie. I don't want to look like a dork when asking my doctor what size he uses. Is it boo-gee, bow-guy?

I would think a bigger pouch would be better because when you reach your goal weight you can eat enough to maintain?

[Elisabethsew 50]

How do you pronounce boughie. I don't want to look like a dork when asking my doctor what size he uses. Is it boo-gee, bow-guy?

I would think a bigger pouch would be better because when you reach your goal weight you can eat enough to maintain?

Your new stomach will gradually stretch from a finger size to a banana size. The smaller the size (bow gee) boughie, the faster you lose weight and the better your chance of keeping it off.

[MacMadame 81]

I would think a bigger pouch would be better because when you reach your goal weight you can eat enough to maintain?

Nope, bigger isn't better in this case. The bigger ones stretch too much over time and weight regain is an issue. My surgeon has been doing this procedure for about eight years now and they used to use a 48 f just like for their DS patients. They saw weight regain with too many patients as early as two years out with that size and now they use the 32 f. There is a study that shows you need to remove at least 500 cc of stomach to have long term success as well.

IMO 32 and 34 f are good sizes and anything 48 f and over is too big. In between 34 and 48 (mostly 36, 40, & 42), I think the jury is out on.

I eat 1100 calories a day right now and I'm only 7.5 months out. I could easily eat 1500 just by making different food choices. There is no problem eating enough to maintain for the vast majority of people. It's always possible to eat more often or to eat more calorie dense foods.

Like with all the different WLS types, many more people don't get to goal or have some regain than have trouble with losing too much.

[WASaBubbleButt 41]

Nope, bigger isn't better in this case. The bigger ones stretch too much over time and weight regain is an issue. My surgeon has been doing this procedure for about eight years now and they used to use a 48 f just like for their DS patients. They saw weight regain with too many patients as early as two years out with that size and now they use the 32 f. There is a study that shows you need to remove at least 500 cc of stomach to have long term success as well.

IMO 32 and 34 f are good sizes and anything 48 f and over is too big. In between 34 and 48 (mostly 36, 40, & 42), I think the jury is out on.

I eat 1100 calories a day right now and I'm only 7.5 months out. I could easily eat 1500 just by making different food choices. There is no problem eating enough to maintain for the vast majority of people. It's always possible to eat more often or to eat more calorie dense foods.

Like with all the different WLS types, many more people don't get to goal or have some regain than have trouble with losing too much.

Did you know that your doc is considering changing from 32 to 36? There was a post on another board about it, I didn't really understand what the poster was talking about. She had a diagram of the stomach and with a 36 they don't have to remove some part of the stomach, forget what it was. Cirangle's thinking is that weight loss will be better because the stomach will empty even more slowly.

Might be a good thing to verify if she was understanding his reasoning.