WASaBubbleButt Lost Weight

2015-02-08T10:34:00.001-08:00

2/8/2015

Let's see, an update on me and an explanation of why I stopped updating this page.

In 11/2010 I moved to Mexicali, Mexico. Around 10/2011 I began working for a surgeon so it was rather inappropriate to continue warning about surgeons. I decided to leave my blog but, not update it. Key information is there on Researching Mexican Surgeons.

I currently work for Dr. Juan Arellano. He is the Vice President of the Mexican College of Bariatric surgeons. They tend to set the tone for bariatric surgery in the country of Mexico. I suspect he will be voted in as President next term.

He also was the starting committee member to begin board certification for Mexican bariatric surgeons. Today surgeons doing your weight loss surgery should be board certified in General Surgery as well as Bariatrics. If they can't pass that test, should you really be going to them?

Dr. Juan is also one of two surgeons vetted in DS and he is the only surgeon in Mexico qualified to revise from RNY to DS.

I now have several f/b pages.

One is for regain and/or revision bariatric patients.

https://www.facebook.com/groups/130465167129885/?ref=bookmarks

Another is for Failed Bands. Usually it's not the patient that fails the band, it's the band that fails the patient. 50% of bands of any brand are removed in the first 2-6 years post op, most of these people go on to revise to a better, safer surgery type and do quite well. So, most of the time it is not the patient, it is the band. This page is designed to help people deal with band issues and move on with their lives.

https://www.facebook.com/groups/759720587436129/

I have a page for facts about WLS. There are so many myths and old science being posted all over the internet regarding bariatric surgery I decided to start a page for just the facts.

https://www.facebook.com/groups/WLSFacts/?ref=bookmarks

Then, yesterday I realized there is still a desperate need to show people how to research Mexican surgeons. So, we are working on a page that is similar to this blog but it will be kept updated.

https://www.facebook.com/groups/792773314105638/?ref=bookmarks

Please note, the above page is under construction, we hope it will be up and running in a few days or a couple of weeks.

Many people are going to these dirt cheap surgeons in Tijuana for sleeves. Please be aware, if you do this you are not getting an actual sleeve. This is what they are doing:

When a surgeon does a sleeve one of the biggest costs to the surgeon is the titanium. The staples. It's the biggest cost for medical supplies. It takes (usually) about 8 packs of staples to do one sleeve.

What these surgeons are doing is sleeving the bottom 25% of your stomach and that takes 2 packs of staples instead of 8. A MASSIVE cost savings to your surgeon. Then the plicate the upper 75% of your stomach.

Well, we know plication is temporary, it does not work long term. So a few years down the road these people suddenly lose restriction. They go get an upper GI (barium swallow) and the find their upper stomach is huge. At this point they call their surgeon in Mexico to ask what the deal is and the Mexican surgeon will *always* blame the patient telling them they stretched out their stomach. They ate too much food repeatedly.

Well, you know what? That's what we do. We eat too much. We always did, that is why we needed restriction to begin with. Surgery doesn't magically fix that so we still tend to push the limits post op. If we *can* eat we *do* eat, that is what we do. That does not mean your stomach goes back to almost normal size. Yes! Push the limits and you can dilate your sleeve, but not to almost its original size.

Then the patient has to go to an actual "revision" surgeon to fix what is wrong and only when the REVISION surgeon is looking at the stomach can it be determined what happened.

It's not the patient's fault. It is the fault of the original surgeon. When you look at the stomach there isn't a single staple in the upper 75% of the stomach. Just scarring from plication that gave away and now the stomach is huge again. The upper portion of the fundus was never removed to begin with. This also explains why the patient is so hungry, they are still over producing Ghrelin, the hunger causing hormone. When you remove the fundus of the stomach properly, you remove about 80% of Ghrelin. When you leave the fundus and just sew it up it still produces Ghrelin.

Please don't go to these cheap $3500/$5,000 sleeve surgeons. Flat out, hands down, it is impossible to do a sleeve at those prices. It can't be done.

Either the surgeon is doing 25% sleeve/75% plication OR... he is using black market supplies. There are medical tourism companies based in the US that sell these cheap surgeons knowing full well they are sending patients to horrible surgeons. Oh! The patients LOVE the surgeons! They are nice, kind, charismatic. They treat the patient well. Sadly, I'd venture a guess that most people rate the skill of their surgeon on how "nice" they are. "Nice" does not mean skilled or ethical. It is not until a few years down the road when you lose restriction and the massive regain starts that you will realize that your surgeon wasn't so "nice" after all.

Do your research, go to a real surgeon.

If you have any questions please email me at any time.

Bipley@gmail.com
602 539 0949

Announcements

2010-03-30T17:21:00.001-07:00

**UPDATE**

1/21/2016

Here is an update on Dr. Joffe, previously from Canada an now back in Mexico. Be careful in choosing your doctors, please.

http://www.cbc.ca/beta/news/canada/edmonton/weight-loss-surgeon-with-licence-revoked-in-ontario-for-sex-with-patients-recruiting-in-alberta-1.3412410

A weight-loss surgeon whose Ontario medical licence was revoked for sexually abusing four female patients has been recruiting new patients from Fort McMurray to his institute in Mexico.

An Edmonton clinical ethicist said the "egregious" behaviour of Mexican surgeon Dr. Jacobo "Jacob" Joffe while practising in Ontario highlights the potential risks of "medical tourism."

"Would I be worried as a patient? Absolutely," said Brendan Leier, an assistant clinical professor with the University of Alberta's John Dossetor Health Ethics Centre.

"Unfortunately there is no mechanism, when you travel across a border, to protect Canadian patients and it sounds like the Mexican licensing bodies see the issue differently in terms of having a second chance to treat," Leier said.

A CBC News investigation found that over the last 15 years, at least 250 doctors have been disciplined across the country for a litany of patient boundary offences. Two-thirds were allowed to continue practising, and of those who lost their licences, CBC News discovered three, including Joffe, who moved to other countries to practise medicine.

Joffe is a general surgeon who specializes in weight-loss operations like gastric sleeve and gastric bypass surgery. He practised in Scarborough until December 2008 when the Ontario College of Physicians and Surgeons revoked his medical licence for sexual abusing four female patients over a period of several years.

Joffe did not contest the findings of the college's internal investigation, but those findings only apply to that specific hearing.

The committee found: he hugged and kissed some patients on their lips and told them how sexually attractive they were; had sex with patients regularly at his office, in the hospital and at their homes; and induced one woman to obtain illicit drugs, which he then used with the patient and another female patient.

Clinical ethicist Brendan Leier says patients considering “medical tourism” should first thoroughly research their potential doctors. (ualberta.ca)

The college also found Joffe engaged in sexual threesomes with two of his female patients while using drugs.

The college said Joffe knew his behaviour was unprofessional because he actively encouraged the women to conceal their relationships.

"The (disciplinary) committee had particular regard for the poignant description of the effects experienced by patients noted in their respective victim impact statements, which included humiliation, distortion of normal social relationships, fear of hospitals and physicians, destruction of family relationships, depression, psychological problems and employment problems."

The college levied a fine of $40,000 against Joffe to be used for the women's counselling.

The hospital in Scarborough, and Joffe, later settled a $12-million lawsuit with the patients.

"Preyed" upon patients

At his public reprimand hearing in 2013, as reported by The Toronto Star, a committee member excoriated Joffe.

"Your actions were utterly self-serving," Dr. Marc Gabel said. "You preyed upon the vulnerabilities of these patients and misused the trust that they had in you."

Joffe did not respond to interview requests from CBC Edmonton but in a previous discussion with a CBC Manitoba producer he expressed no remorse for his previous behaviour. Instead, he appealed to the producer's sense of humanity while asking that he not be named in a story.

"It has taken me a long time to get over the disaster in how this played in my life, and how much damage, mentally and physically, this had to do with me and in my life," Joffe said. "It has taken me so long. I mean, it is already seven years and it is not easy, okay?"

After the Ontario college revoked his licence in 2008, Joffe moved to Mexico, where he is a citizen and had received his medical degree, and opened the Advanced Metabolic and Bariatric Institute in Guadalajara.

A spokeswoman for the Ontario college said it notified the Mexican regulatory authority of Joffe's licence revocation, including the disciplinary committee's findings.

His website references a recruitment seminar in Fort McMurray in April 2012 and the institute's Facebook site featured a photo of Joffe with more than a dozen patients from there.

The website features many "success stories" of past patients, which praise Dr. Joffe and his care. Eleven of the 22 testimonials are by patients from from Fort McMurray who paid up to $15,000 for surgery, which includes airfare and accommodation costs. There are also video testimonials from Fort McMurray patients posted on YouTube.

Patients praise surgeon

CBC Edmonton contacted seven patients from Fort McMurray; only one responded.

Kelly Eby of the College of Physicians and Surgeons of Alberta says the college has no specific rules governing patient referrals to specialists.

In an email, Ria Ryan said she was "fully aware of Dr. Joffe's situation in Ontario before I booked an appointment with him for my surgery.

"He came highly recommended from a friend," Ryan said. "I received excellent care in Mexico and I came away respecting Dr. Joffe as a surgeon and a person."

In one testimonial, a Fort McMurray man said he was referred to Joffe by his local doctor. He did not respond to interview requests.

Kelly Eby of the College of Physicians and Surgeons of Alberta said she could not comment on a specific case, but she said the college has no specific rules governing the referral of patients to specialists.

"Any time a family physician refers a patient to a specialist, we have an expectation that that family physician knows that the physician they are referring to has a good quality of practice, they will treat the patients well," she said.

~~~~~~~~~~~~~~~~~~~~

3/21/11

I realize I usually post about doctors in this section but now I have to write about Netrition.com.

I can no longer suggest your using their services. I had no idea how underhanded and lowly these people are. They own a low carb message board and don't tell you they own it, edit posts to suit their needs without telling the poster, and overall are just THE most unprofessional company I do believe I have ever purchased from. I tried calling and was hung up on. I called back to find out the name of the person that hung up on me so I could write a proper letter of complaint and was told by Frank, the office manager for customer service that I don't need that information.

Be very careful of working with such unprofessional people.

3/5/11

More updates on 1800 GET THIN & 1800 GET SLIM

www.ripoffreport.com/weightloss-programs/1800-get-thin/1800- get-thin-1-800-get-thin-8c886.htm

articles.latimes.com/2011/feb/03/business/la-fi-lap-band-201 10203

abclocal.go.com/kabc/story

latimesblogs.latimes.com/money_co/2010/12/michael-hiltzik-a- death-and-1-800-get-thin.html

2/11/11

Please be aware that Thomas Umbach, MD in Las Vegas, NV sells collagen protein tablets to prevent excess skin and cellulite. This does not work, there is no known peer reviewed journal article that supports this. Excess skin is damaged skin, it's like taking these same tablets to fix damaged hair. Once it is damaged, it is damaged. It is stretched, it has lost elasticity, and the only true fix is removing the excess skin if you really don't want it. Please don't waste your money. It is bad enough that stores sell us snake oil, it is unfortunate when a bariatric surgeon does the same thing.

Collagen is great for injecting under the skin to fill small folds, but tablet versions will not work! It will not do a thing for your thighs or stomach but it will do a great deal for his wallet.

Here is one of Dr. Umbach's patients, read carefully and do your research!

http://www.obesityhelp.com/member/adwinters12345/

6/23/10

Please note that Dr. Ariel Ortiz in Tijuana, MX is claiming to have been doing sleeves for over a year, he claims over 300 sleeves. Considering he just went to my surgeon a couple of months ago to start his training in sleeves and as of six months ago he was refusing to do sleeves saying it was nothing more than stomach mutilation, it's highly unlikely he was 'mutilating' stomachs a year ago. I'd venture a guess he has less than 10 sleeves. Be careful, use common sense, find those 300 sleeve patients, heck... find 20! If he's doing almost one a day they should be posting like crazy on the boards. Do you know any? I don't. Doctors will claim any stats because if they tell you the truth that they have zippo sleeve/staple line experience, would YOU go to them? They know this so many doctors inflate their stats. RESEARCH! It's critical to your health.

If you call his office his staff will tell you I am dishonest, a troll, and use multiple IDs. Read my posts for yourself, I am not a troll. I have changed my ID from MidwesternGirl on OH to my usual, WASaBubbleButt. It's right in my sig on every single post I write, "Previously MidwesternGirl." How is that trolling? They also claim I work for my doctor, that is a flat out lie. It's just a con job, they try to discredit me instead of being honest about his stats. They are trying to sell you surgery, I sell nothing. Look for yourself, am I selling anything on this blog? In my posts? No, I am not. What do I have to gain by your believing me over someone trying to sell you a very expensive surgery type?

Just do your research.

6/13/10

1 800 GET THIN and 1 800 GET SLIM - WARNING:

From the news article:

Brooks had surgery to implant a lap-band -- a silicone ring fitted around the upper stomach to suppress appetite -- last June 5 at a surgical facility in Beverly Hills operated by Top Surgeons, the sponsor of those 1-800-GET-THIN and 1-800-GET-SLIM billboards that have become as inescapable on Southern California freeways as smog in summer. He was sent home to Perris with a prescription for oxycodone painkiller and instructions to return in a week.

Three days later, Brooks was dead. At the autopsy, a Riverside County coroner found stomach contents leaking around the edges of the lap-band and more than a liter of pus in his abdomen. On her report she listed the cause of death as "peritonitis due to lap-band procedure due to obesity."

Read more here:

http://www.latimes.com/business/la-fi-hiltzik18-2010apr18,0,3957577,full.column

***EDIT*** 2/18/11 A FORTH Lap Band patient has died as a result of this clinic. Yes, folks... that is FOUR people, dead, due to the actions of these doctors. Please read the following article:

http://www.chicagotribune.com/topic/la-fi-lap-band-20110211,0,1272514.story?track=rss-topicgallery

5/10/10

Dr. Christine Ren of NYU has admitted altering medical records to hide the fact that she and her husband, Dr. George Fielding, were using unlicensed physicians in the operating room and for follow up care of WLS patients. It is thought that this is one reason one of her patients passed away (her Med Malpractice paid out $973,000 to the estate of the patient). Dr. Neelu Pal, the doctor that was the whistle blower is currently suing because Drs. Ren and Fielding were able to get her fired for telling what she knew.

See more here:

http://www.nypost.com/p/news/local/manhattan/fat_in_the_firing_for_rex_doc_Xk1P6kDfm3HcaGJ6j87X1L
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

4/15/10

Please be aware that Dr. Jacob Joffe, previously a licensed surgeon in Canada, has moved to Mexico and is practicing there. He has a long history of sexually assaulting his bariatric patients.

http://www.ambisurgery.com/about-surgeons.php

http://www.weightlosssurgerychannel.com/breaking-wls-news/bariatric-surgeon-hospital-hit-with-class%E2%80%90action-suit.html/

Don't be a victim!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
4/10/10

Please be aware of a clinic in Tijuana, Mexico (MISTER Betancourt) that has been harming people left and right. As of this writing in the last six months they have had over 50 infections, over 10 staple line leaks, perforated stomachs, spleens, and livers. These are more complications than most surgeons have in an entire career.

They claim to be a licensed hospital. They are an unlicensed clinic. They recently "purchased" a license from the Mexican government, as Mr. Betancourt boasts.

They claim the owner is a Medical Doctor, he has yet to even finish Jr. high school.

They claim the surgeon, Almanza, is board certified in surgery, he is NOT board certified in surgery.

There are fantastic surgeons in every country and there are butchers in every country. The US is no different and you are not assured of having a safe surgery merely by staying in the US. I do not care if you have your surgery in the US, Mexico, India, or in outer space - research is key. Do not ignore the bad because the price is right. This is your life and you owe it to your family to go to an experienced, skilled surgeon that has earned a positive reputation.

Sandy Johnston is a big promoter of Hospital Jerusalem, aka Mr. Betancourt, aka Betancourt Medical, aka Mt. Zion aka Emmanuel. She will try to talk you into surgery with a dangerous surgeon. She makes around $1500 off your surgery if you go to Almanza. She has posted a fake medical license for Mr. Betancourt, she has claimed that Dr. Almanza is board certified in surgery (he is not), she has claimed that in Mexico things are done differently, if you want to be board certified you pay a website and you are board certified. This is not accurate. To be board certified in Mexico you do it exactly like in the US, you pay a fee to take a test, if you pass the test you are board certified.

She attempts to discredit my push to do your research by claiming I am a coordinator and that I only push my doctor on various weight loss boards. If you will see my posts I don't recall ever starting a thread about my doctor, the only time I discuss my doctor is when specifically asked, and when asked who is good I offer three names of doctors I would personally be willing to go to in Mexico, not one.

For the past few months she has claimed to many people via PM and phone calls that she and I are in federal court in litigation. This is flat out - a lie. I live in Mexico, if we were in federal court wouldn't she be somewhat aware that I don't even live in the United States? She was unaware I was living in Mexico when she was making these bogus claims. It was another attempt to discredit me for pushing YOU to do your research before having major surgery in any country.

My question for Sandy would be this, why does Sandy try so very hard to discredit someone encouraging that you research your surgeon instead of just trusting any coordinator to tell you what you need to know? A coordinator's job is to sell surgery. Period. (Think 'used car' salesman.) If you do not have surgery through the doctor they are pushing, they do not make money. If the surgeon they work for is so great, why the push to discredit someone encouraging research?

I do not push any one surgeon, I do push research, it is pretty much my mantra.

Sandy Johnston is not honest about Dr. Almanza, Mr. Betancourt, or me. I have let this go for far too long, now I am speaking out.

Do your research.

What I Learned About Surgery In Mexico

2010-03-30T12:36:00.000-07:00

What I have learned about surgery in Mexico:

When Dr. Campos asks if you are doing your trippy little breathing exercises, telling him you are is of little value when you can't quite recall what you did with the machine. He will find it for you and watch you actually use it.

Ditto on the breathing machine with Dr. Aceves.

Feeling pride - to the point of boastful - of your Spanish skills when telling the nurse you would love nothing more than to run outside for a cigarette actually translates into: I just smoked a cigarette inside the hospital and I'd like another, please. At least that is how they understand it. I'm quite sure my Spanish is better than those from Mexico.

Pointing to your stomach and saying, "Ouch ouch ouch," is medical Spanish for "May I have pain meds, please?" Clutching your gut and gagging is medical Spanish for, "I'm gonna hurl, I have something for nausea please?"

Pain meds do not taste like candy. Nurses fib.

Feeling pride that you finished your crushed tablet and water is short lived. Nurses belong to the clean plate club. They will look and see there is tablet residue on the bottom of the cup and pour more water in there so you can enjoy it a 2nd time around. Having the expression of a 4 year old that just ate spinach while drinking crushed tablets and water will make the nurse laugh.

Quality doctor/patient time is done by sneaking outside the hospital to grab a quick cigarette. You see, Dr. Aceves finds smoking most annoying and this behavior leads to a variety of lectures ranging from slow healing, health issues, etc. Just look at him wide eyes and nod like you are learning something new!

Trying to explain going outside by telling any of the medical staff that you are merely trying to get some exercise is fruitless. They won't buy it.

When you wash your hands and accidentally drop the paper towel you used to dry them, you naturally bend over to pick it up and throw it in the garbage. When you get halfway down to pick up the paper towel you discover it is much easier to kick it in a corner.

Feeling guilty about kicking the paper towel in the corner leads you to kick it over to the couch like a dodge ball, sit down, and SLOWLY bend over to pick it up. Of course, this means you must stand up again and walk to the garbage. Since your suitcase is on the couch within reach you throw it in there and decide to call it a souvenir from Mexico.

Sleeping on your side is tricky business. It takes a few moments to slowly turn to your side while muttering damn damn damn due to discomfort. You finally lay on your side, clutching the pillow to your stomach. You are blissfully comfortable, sigh a sigh of relief, and without fail Dr. Campos will walk in and want to see your incisions. This is guaranteed to happen 100% of the time. Matter of fact, I am convinced this is how to get Dr. Campos to come to your room. If you have a question and would like to see him there is no need to request a nurse contact him. Merely take the time to turn on your side, mutter damn damn damn due to discomfort, get *really* comfortable, and within minutes he will come to your room and you can ask your question.

As soon as he leaves you slowly repeat the process. Turn to your side, mutter damn damn damn, get comfy and Sergio will come in wanting to see your sutures.

When the folks that had surgery the day before you come in to check on you, don't mess with them because I am here to tell you, these people mean business. Before you know it the gauze version of TEDS hose on your lower legs is suddenly removed and you discover your butt is hauled out of bed and you are doing laps up and down the hallway dragging your IV pole with you. The day old bandsters will cheer you on. Just remember, tomorrow it will be your turn to play "day old drill sergeant bandster," to the newbies.

Your first poop will hurt. Deal with it.

Experience is a wonderful teacher. When it's time for your 2nd poop you think it through and decide you can wait for another day.

When you accidentally bust open and clot off your IV in front of Dr. Aceves - suggesting to him that you, the patient, remove the IV it is not an option.

When the real newbies are there the day before their surgery for labs, xrays, etc., it's a fun time to show off your incisions. They actually WANT to see them unlike the rest of the free world.

The idea of broth and orange jello for breakfast is something met with anticipation. It almost borders with excitement when you see the nice lady from the kitchen with your tray.

If you thought you had a Buddha belly before surgery, check it out after surgery. The gas they use to blow up your belly is still there. You actually wonder, when you finally start burping will it sound like you just inhaled helium as you speak?

When Dr. Campos asks you if you are passing gas it is a toss up trying to decide if you should remind him that is not a question one asks a lady or if you beg to know when you actually WILL fart/burp up a storm. Your gut looks like if you get near a sharp pointy thing it will pop like a balloon.

Glue is a funny thing. The medical staff will tell you that they put a plastic film (much like saran wrap) on your stomach before surgery. It's a 'clean' issue. They are not telling you the truth. When you are having surgery they pour epoxy all over your stomach and later, when you shower you realize it will never come off. It is there for life and you question if it will tan with the rest of your skin the next time you lay in the sun or if it will be blotchy and yicky. The real secret... if you look at it carefully you will see the logo of Almater hospital in the permanent glue.

I double dawg dare you to lean against something with the epoxy on your stomach. You'll be stuck to what you are leaning to like strong Velcro. Prying your epoxy covered gut off the counter you just leaned against to wash your hands is similar to prying apart two of the strongest magnets that you have ever experienced. Much weight loss is accomplished this way as your skin is still stuck to the counter. I estimate 4 pounds.

The day after surgery - if you discover the epoxy on your stomach has formed mini glue balls under your breasts you realize it's time for a breast lift.

Much bottled water, ice, broth, tea, Jello, juice, and IV fluids. Guess where you will be spending time between laps through the halls and naps?

Viva la Mexico!!!!!!!

Is Weight Loss Surgery For You?

2010-03-29T15:49:00.000-07:00

If you are here you are likely either thinking about WLS or you have already had WLS. Either way, you are in the right place.

I think most obese folks consider WLS and due to the unknown we tend to fear it. Everyone knows someone *or* knows someone that knows someone that had serious complications including possible death from WLS. WLS isn't as scary as it sounds, to be honest obesity carries more risk than the surgery itself. We tend to get used to the risks associated with obesity but surgery? Not so much. We don't worry as much about high blood pressure, diabetes, sleep apnea, joint damage, heart disease, dialysis, and all the other complications that go with obesity but the fear of surgery scares many away. This is not acceptable, surgery is safer than obesity!

You have probably tried to lose weight before, right? Are you still trying? Please tell me in detail how well you are doing with this task? Some can lose weight but they cannot keep it off. Others are unable to lose weight to begin with. This is NOT your fault! Obesity is a disease, it is not a character flaw. Recent studies coming out of Canada are showing that doctors who suggest traditional diet and exercise for weight loss in the obese are seriously under-educated about this disease and if they understood what they believe they know, they would realize the chances for our losing weight on our own are close to zero percent. Old studies show those who are obese and diet and exercise their way to a healthy BMI make a whopping total of 4% of us. New studies indicate that is 0%. I will post this study elsewhere.

Jenny Craig, Weight Watchers, meals delivered to your home... do you know what all these have in common? They all survive on repeat business. Stop and think about how many people you know (including yourself) that have tried these? Many lose quite well. Kirstie Alley comes to mind. She did very well but as soon as she stopped the program she regained her excess weight and maybe added a few pounds on top of that. These programs survive on repeat business, people lose well, stop the program, regain, and return to do it again. Is this really productive?

WLS isn't a sin, obesity isn't a sin. It isn't a character flaw either. It is a disease. It's time we all start treating it as such. Being obese is not a horror, staying obese is a horror and especially if you have options. Where there is a will there is a way.

Typical feelings we have about ourselves is a lack of discipline, a lack of self control. A lack of self esteem is common. I will cop to them all! I just didn't have what it took to do it on my own. But then had I been diabetic I couldn't have treated that on my own without medical intervention either! We often times start hating ourselves, our lack of ability to lose weight, we don't like the way people look at us, we don't leave our homes, self loathing. It's all a part of what we go through.

Surgery does not cure everything but it sure gives all of us an opportunity to start a new life with improved self esteem.

Take a chance, get your life back!

What Is A BMR? (Basal Metabolic Rate)

2010-03-28T15:53:00.000-07:00

What is a BMR? A BMR is your Basal Metabolic Rate. It basically means if you stay in bed all day and do virtually no exercise, how many calories does it take to maintain your body.

When I was at my biggest of 252 pounds my BMR was 1,850, or in other words the calories needed for my body to keep my heart beating, my brain functioning, my lungs breathing was 1,850. The bigger your body the more calories it takes to maintain that weight.

When you lose weight your BMR goes down so it takes fewer calories just to maintain. Today my BMR (considering I am a few years older and a lot of pounds lighter) is 1,262.

So for comparison purposes---

252 pounds I needed 1,850 calories just to maintain my weight.
120 pounds I need 1,262 calories just to maintain my weight.

If you add exercise to the equation then I need more calories just to maintain my weight. This is why the bigger the person the faster they lose in the beginning.

You can "kinda sorta" gauge how much weight you will lose in advance by knowing your caloric intake, the number of calories used to maintain your weight, and how many calories you are burning daily.

If each pound is worth 3,500 calories (and it is) and my BMR is 1,850 calories, then we have the following:

3,500 - 1,850 = 1,650

So this means that if I just eat enough calories to maintain my weight I should lose about 1/2 pound of weight daily. Add exercise to the mix and I'll lose even more.

This is not an exact science, this is an estimate. Your metabolism is not the same as mine and my metabolism is not the same as your mother's. We are all different.

Here is a calculator to measure your own BMR:

http://www.bmi-calculator.net/bmr-calculator/

At the same token when you are bigger and you walk on your treadmill at 2 miles per hour for 30 minutes, you are going to burn MORE calories than if you weigh 100 pounds less and do the same exact exercise. This is why the closer you get to goal the harder it is to lose those last few pounds. It takes more calories for a bigger body to walk 2 miles per hour for 30 minutes than it does for a smaller body to walk 2 miles per hour for 30 minutes.

Make sense?

What Is A BMI? (Body Mass Index)

2010-03-27T09:43:00.000-07:00

What is your BMI? Simply stated, it is your body fat based on height and weight.

I am 5' 5" and at my highest I was 252 pounds or a BMI of 41.9. Today I am 5' 5" and I weigh 120-125 for a BMI of 20.0 - 20.8.

The reason the medical community uses BMI is because weight alone doesn't really tell us much. My sister is much taller than I am so if I weigh the same as she does at a healthy weight for her, it would be overweight for me. If you figure that 160 pounds is a healthy weight for her, that would make me overweight because I am so much shorter than she is.

To calculate your BMI multiply your weight in pounds and divide that by the square of your height in inches. Or, make it easy on yourself and use a BMI calculator:

http://www.nhlbisupport.com/bmi/

What is your BMI? Where does it fall within the following:

Less than 18.5 = Underweight
18.5 - 24.9 = Healthy or normal weight
25.0 - 29.9 = Overweight
30.0 - 34.9 = Obese
35.0 - 39.9 = Seriously Obese
40.0 - 49.9 = Morbidly Obese
50.0+ = Malignantly Obese or Super Obese

Now, with the above written I must tell you that the BMI chart is not a one size fits all. Not everyone falls within the standard BMI figures. Let's take a body builder for example. They may not have an ounce of fat on their body but their BMI may show overweight or even obese! It's not fat, it's muscle and they are not overweight or obese. However, let's get real here. If you are reading this blog for you or on behalf of someone else they are not likely a body builder but simply written, they have too much body fat. That's okay, it's not a sin. It is not a sin to be overweight, it is a shame not to do anything about it and that is what this blog is all about. Recognizing where we are today and deciding what options we have to fix the problem.

It should be noted that if you are in the category of a BMI of 25 or greater, you are in the majority of the US population and many other countries. In the US today it should be noted that 1/3 of us are healthy weight, 1/3 of us are overweight and 1/3 of us are obese. But that's okay, it's not the end of the world. We have lots of options available to us and we all need to find the trick that works for us. The trick that helps us to overcome weight issues and get our lives back.

You Want Surgery, So Now What?

2010-03-26T20:20:00.000-07:00

So now that you have chosen a surgery type, now what?

Now you need to research to see if your insurance covers WLS. Most people who have medical insurance do not have WLS benefits. If you have WLS benefits, count your lucky stars!

WLS benefits are covered under group policies only. Private policies do not cover WLS and the reason is that all the people (majority) who do not have WLS benefits would be buying private policies in order to have insurance companies pay for their surgery. As soon as their surgery was complete they would drop the policy. No insurance company could afford that for long. Thus, private policies do not cover WLS.

Group policies do cover WLS IF the WLS premium is paid. Let's say you work for a large company, your chances for having WLS benefits are good. Typically the larger companies will pay the additional premium for WLS. If you work for a smaller company it is unlikely you have the right benefits. Smaller companies cannot typically afford the expensive premiums. They cannot just cover one or two employees, it is all or none. Either they have to cover all employees or no employees.

Call your insurance company, ask if you have WLS benefits. Regardless if they say you do or you do not verify this with your own eyes. When you call your insurance company you are talking to a first level employee. They are not typically experts in insurance. Whether or not they claim you have benefits ask them to email you a link to your on line policy showing where WLS is included or excluded. Do not take their word for it.

If you do have WLS benefits ask them what you need to do to qualify for surgery. Most companies require part or all of the following:

A BMI of 35 or greater and very specific comorbidities such as high blood pressure where you need medications to control your disease. Borderline hypertension that is controlled by diet and exercise does not count. And/or, diabetes and no, prediabetes does not count. You must be a full blown diabetic on medications to control your blood sugar. Things like a family history of obesity, high blood pressure, diabetes, these do NOT count. Your insurance company does not care if your mother is diabetic or not, they want to know if YOU are a full blown diabetic.

Issues such as joint damage, back pain, headaches, PCOS, asthma, ... none of these issues matter. Well, they do to you but they do not matter to your insurance company in the least when it comes to qualifying for WLS.

If you do not have medical comorbidities such as the above you must have a BMI of 40 or greater.

Some insurance companies require you to prove through various types of medical records that you have had a BMI of 40 or greater for the last five years.

Some insurance companies require you to do a 3-6 month medically supervised diet. This means (usually) that you have to go to your nutritionist or physician every month for 3-6 months to be weighed and measured. Then your health care professional must document that they weighed and measured you and discussed with you diet and exercise. If you miss as much as one appointment your insurance company has the right to make you start over the entire medically supervised diet.

Many insurance companies require that you go to a nutritionist for an evaluation of your diet.

Many insurance companies require that you go to a bariatric surgeon to evaluate your weight.

Many insurance companies require that you go to a psychologist for a psych evaluation.

Many insurance companies require that have a sleep study done to see if you have sleep apnea.

Let's be honest here, they do not make this an easy process.

What if you do not have WLS benefits on your insurance? Well, welcome to the world of self pay. I'm not being snitty, I've self paid twice so I fully understand. Once for a Lap Band and again for a revision from band to sleeve. If you are in this position I can empathize with you. Please note, there are no organizations that will give you money for WLS. No doctors will do your surgery for free. They are asked on a daily basis and they would go out of business if they did free surgery, the costs associated with WLS are great in number. The cost of a Lap Band is $4,000 and that is just for the band. That does not include OR time, the anesthesiologist, medications, anesthesia, nursing, or all the other costs associated with surgery.

One of the many issues I have learned over the last four years is that if someone wants surgery badly enough, they will find a way to get it. Some save for years, some take from their childrens college funds. Some refinance their homes, some sell off personal items, some get 2nd and 3rd jobs to pay for surgery. People that want it bad enough find a way. It's a cold and harsh reality, yet true.

The next step is to find a doctor. Now, I realize this sounds odd. Most would have their surgeon help them pick a surgery type. That's fine as long as you go to a surgeon that does all the major procedure types. For example, let's say you want Gastric Bypass and you go to a surgeon that is a band mill, meaning they only do Adjustable Gastric Bands. They sell a product, their product is a Gastric Band. If you go there asking about a procedure they do not know how to do they are going to tell you the evils of all surgery types they do not do. Let's face reality here, doctors are in business to make money just like the rest of us. We all go to work to earn a living. Asking a band mill surgeon about Gastric Bypass is like asking a Toyota dealer to tell you all the best aspects of buying a Honda. They are going to push what they sell. Thing is... *you* are the person that has to live with your surgery type for the rest of your life. It is you that has to decide just what you can live with and what you cannot live with.

So either decide on a surgery type and then choose a surgeon that does that surgery or go to a surgeon that has no vested interest in which surgery you choose, you will get a much more balanced answer and more balanced suggestions to consider.

Please see "Researching Mexican Lap Band Doctors" on how to research your doctor, it will work for both US and MX surgeons. Please see "Researching Mexican Sleeve Surgeons" on how to research your doctor, it will work for both US surgeons and MX surgeons for sleeves and bypass. For DS the doctors are extremely limited and you should check on the www.DSFacts.com website for suggested surgeons.

If you have WLS benefits on your insurance get a list of all the doctors they contract with and start going to seminars. Remember, go to a surgeon that does the surgery type YOU want. YOU have to live with this surgery type for the rest of your life, don't let a surgeon talk you into the surgery type he performs instead of the surgery type you want. I promise you, you will regret it if you don't.

If you do not have WLS benefits on your insurance plan, or if you do not have insurance at all then you can go to any doctor you wish. Remember, medical tourism is a growing industry. Surgery is MUCH cheaper and equally as good (with the right research) outside of the US. I did it, lots of people do it. I went to Mexico for my band as well as for my sleeve.

Go to lots of seminars, meet the doctors (if in the US), get a feel for them. See which doctor you feel comfortable with. In some ways the most important issue is surgical skill but you know, unless you get a sleeve you'll need follow up care for the rest of your life. You really need to go to someone you like and trust as well. If you hate your surgeon you are less likely to go for follow up care and that will affect your weight loss.

There is such a thing as a Center Of Excellence or a COE. You will see this often on various WLS message boards. Please do not assume this makes the surgeon good. Some of the worst surgeons are a COE, it merely means the hospital they work out of meets certain requirements. It means absolutely NOTHING about surgical skill.

Choose a surgeon with lots of experience. There is a learning curve to every surgical procedure including removing toenails! Don't be the guinea pig, be the patient that goes to a good, experienced surgeon with great stats, lots of skills, and oozes compassion and understanding of obesity.

Now it is time to choose a surgery type and get your life back!

Which Surgery Type Is Right For You?

2010-03-25T20:26:00.000-07:00

There are several surgery types but there are four that are the most popular. I'll start with the top four from least invasive to most invasive. Keep in mind, the less invasive the surgery the less weight you will lose, statistically. The more risk you have for surgery the more you are likely to lose.

*****If you take nothing else away from this section of my blog please understand one thing, there is NO surgery type that fixes white carbs. No surgery type will prevent you from absorbing sugar, flour, rice, or pasta. That one is on us to change, not the surgery. Surgery is just a tool for us to lose our own weight. We can have surgery to limit the quantity of food we eat, we can have surgery to prevent us from absorbing all the calories that we consume but no surgery type prevents us from absorbing every white carb we consume.*****

ADJUSTABLE LAP BAND

Inamed, Inc originally came up with the Adjustable band and later sold the rights to the Lap Band System to Allergan who currently owns it. This band was approved by the FDA for use in the US in 2001.

The band is a restrictive only procedure meaning that it will limit the quantity of food you can consume at one time but you will not malabsorb nutrition or calories.

The Lap Band System was originally approved in Mexico in 1991. The Mexican doctors are the surgeons that perfected the surgical technique used today. Mexican surgeons were also the primary proctor surgeons (Proctors train other surgeons in a given procedure or technique.) that trained US surgeons in 2001. They still proctor many surgeons in the US and other countries. An interesting side note is that when Inamed owned the Lap Band System they had more strict requirements to be a proctor. You had to have at least 100 bands under your belt and low complication/morbidity stats before you could train another surgeon. Since Allergan took over they only require that a surgeon has performed 10 bands before they can teach another surgeon. The reality is that proctoring has "dumbed down" to "watch one, do one" and this is unfortunate. In order to be Allergan certified you must be proctored by another surgeon. When Inamed owned the rights to the Lap Band they would revoke a certification if the doctor proved to have a higher than normal level of complications. When Allergan took over they changed the policy, returned certifications to all surgeons that previously had high complication and morbidity stats. My personal opinion? They just want to sell bands and lots of them.

Johnson and Johnson decided they wanted a piece of the pie and their band, the REALIZE band was approved by the FDA in 2008. They claim big differences between REALIZE and Allergan Lap Band System but to be honest? They both work about the same way. The significant difference for patients is the port. I don't care for port placement of the REALIZE band but the Allergan is taller and tends to stick out more at goal.

About the band...

The band is a silicone band that goes around the upper part of your stomach creating a pouch. Your stomach takes on the shape of an hourglass. The whole idea is that you eat filling the upper pouch of your stomach and you can get full on a small quantity of food. There is a narrow pass through from your upper to lower stomach, it takes time for food to drain from your upper stomach to your lower stomach. There is a nerve at the top of your stomach called the Vegus nerve. This is the brain of your stomach, it basically tells your brain when you are full. So, you stay full on a small quantity of food for an extended period of time.

Three advantages of this surgery:

1) Least invasive
2) Removable
3) Up front surgery fees are more affordable than other surgery types

Three disadvantages of this surgery:

1) Slowest weight loss, least weight loss, highest regain, most mechanical problems of all main surgery types
2) Maintenance for life, hard to find follow up care if your surgeon moves, retires, etc.
3) Very high complication rate and costly for self pay folks

VERTICAL SLEEVE GASTRECTOMY

The VSG is a restrictive only procedure meaning that it will limit the quantity of food you can consume at one time but you will not malabsorb nutrition or calories.

The VSG (aka Sleeve) is where your surgeon will surgically make your stomach smaller. Your stomach has an elastic portion called the fundus. The fundus of your stomach can hold 18 cups of food. Clearly, this is not a benefit to those trying to lose weight. In the sleeve procedure your surgeon will remove the outer curvature of your stomach leaving a small, banana shaped portion of your stomach.

Studies show that obese people tend to produce three times the amount of Ghrelin as a naturally thin person. Ghrelin is a hormone that is mostly (but not all) produced by the stomach and Ghrelin is what tells your brain that you are hungry. People with the sleeve tend to lose the majority of their hunger. Doctors are not in agreement if Ghrelin will return later in life. Quantities of food vary from surgeon to surgeon but theoretically when your sleeve matures in 4-6 months you should be able to eat about 3oz of solid, dense protein such as steak or about 6oz of soft foods such as cottage cheese.

There is a bit of history with the Sleeve procedure. It used to be part one of a two part procedure. Today it is used as a stand alone procedure. If someone has a very large BMI they are often times too high risk for a full Gastric Bypass or DS surgery. So traditionally surgeons have performed a sleeve procedure and sent the patient home to lose enough weight to make a riskier and longer procedure safer. Later they come back and have the malabsorption added to their surgery type. Today they are making smaller stomachs and not doing the malabsorption for those that merely want restriction alone. The procedure itself is NOT new, what is new are the weight loss statistics since it was previously used as part one of a two part surgery.

There is a chance of a vitamin B12 deficiency. Your stomach produces an enzyme called Intrinsic Factor or IF. IF is needed to absorb Vitamin B12 via the stomach. Some people produce less IF after surgery and they need to take Vitamin B12 under their tongue instead of swallowing a tablet.

Three advantages of this surgery:

1) Safest surgery LONG term of all WLS types
2) Drastic reduction in hunger due to removing the portion of the stomach that over produces Ghrelin
3) No maintenance, no aftercare

Three disadvantages of this surgery:

1) Not reversible
2) Less than 1% additional *surgical* risk over the Adjustable Band
3) Risk of B12 deficiency

ROUX-EN-Y aka - GASTRIC BYPASS aka - RNY

Gastric Bypass is considered the Gold Standard for WLS in the US. Many believe the Adjustable Band and Gastric Bypass will be considered "yesterday's procedures" and the VSG and DS will be tomorrow's procedures due to better weight loss and improved resolution of comorbidities. This topic is under debate by both surgeons and patients. But the fact remains that the Gastric Bypass procedure is probably the most common surgery performed today in the US.

This is the preferred method of performing gastric bypass surgery. In Roux-en-Y, your stomach is stapled to create a small pouch and a passage for food to go around (bypass) a section of your small intestine.

A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower "remnant" pouch and then re-arranges the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different GBP names. Any GBP leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food. The long-term mortality rate of gastric bypass patients has been shown to be reduced by up to 40%; however, complications are common and surgery-related death occurs within one month in 2% of patients depending on the target group being studies. Bottom line is the larger the patient and the more illnesses (comorbidities such as high blood pressure, diabetes, etc.) the higher the risk due to the invasive nature and length of the surgery.

This surgery type is ideal especially for Type II diabetics and those with uncontrolled reflux (GERD) not caused by a hiatal hernia or obesity.

The problem with this surgery type is that the stoma (pass through from pouch to small intestine) can dilate in as much as 1 in 5 patients. This causes a complete lack of restriction 2+ years post op. The stoma is designed to keep food in the pouch to provide satiety for several hours after eating. If the stoma dilates, or stretches, there is nothing holding food in the pouch and the patient tends to feel hunger all the time. Since Bypass folks only malabsorb calories for 6-24 months, if their stoma dilates they are hungry all the time and 3 years post op they are no longer malabsorbing calories... the regain starts.

Many believe that Gastric Bypass is not reversible. Theoretically it is totally reversible. This does not mean you should go into this thinking if it does not work you can always have it reversed. It is a huge and major surgery to try to reverse and it cannot always be done. Many believe the surgery is not reversible because intestine is removed. Intestine is not removed in this procedure, it is bypassed thus the name, Gastric Bypass.

For every 120cm of small intestine bypassed people tend to malabsorb about 33% of calories. This is not a permanent feature. We all have something in our intestines called villi. Villi are responsible for absorbing fat, calories, and nutrients. The body has an amazing way of compensating for alterations we choose to make. Within about 2 years the body creates more villi to absorb fat and calories and the patient will never absorb nutrition properly again. Nutrients are absorbed in very specific parts of the intestine, for example iron is absorbed directly under the pyloric valve (the part of the stomach that controls how fast the stomach is emptied to the small intestine, this is bypassed in RNY folks, btw) and this part of the intestine is bypassed so you will need to take supplements for the rest of your life to make up for this. If you cannot or will not take supplemental protein, vitamins, and minerals and if you will not agree to have vitamin labs done at least annually you should NOT have this procedure.

A Welsh study recently announced that 85% of the time within 10 days of surgery patients are in full remission of Type II diabetes. This is significant in the sense that it is changing the way science is approaching diabetes in prevention as well as treatment.

Three advantages of this surgery:

1) Ideal for Type II Diabetics and those with uncontrolled reflux not caused by a hiatal hernia or obesity
2) Fast weight loss the first year especially for insulin resistant people such as PCOS patients
3) Dumping - some consider this to be an advantage, some consider it a disadvantage. For about 1/3 of bypass patients if they consume high sugar or high fat foods they "dump" and for many this keeps them on the straight and narrow, it keeps them from eating foods that are not ideal for weight loss.

Three disadvantages of this surgery:

1) Significant morbidity rate for very high risk patients
2) Ability for the stoma to dilate causing increasing hunger and weight regain
3) Side effects such as reactive hypoglycemia, possible seizure disorder, vitamin deficiencies, and necessity for labs annually for a lifetime. When this surgery works well it works very well. When complications happen they can be quite serious.

DUODENAL SWITCH aka DS

In this procedure, the surgeon removes about 80 percent of the stomach, forming a thin sleeve-like stomach. The valve that releases food to the small intestine remains (duodenal switch) along with a limited portion of the small intestine that normally connects to the stomach (duodenum). The surgery bypasses the majority of the intestine by connecting the end portion of the intestine to the duodenum near the stomach (biliopancreatic diversion). This weight-loss surgery is effective but has more risks, such as malnutrition and vitamin deficiencies, and requires close monitoring.

This is a procedure that is nice in the sense that the first half of the surgery is a Vertical Sleeve Gastrectomy and the second half is the DS, or bypassing of intestine. There is no concern for dilating a stoma as in Gastric Bypass and the long term weight loss is the best of all surgical procedures. But as explained earlier, the thing about WLS is that the less the risk, the less the weight loss. The greater the risk in surgery the greater the weight loss. This is the greatest risk of all surgery types for malnutrition and various vitamin deficiencies yet it provides the best long term weight loss stats. It does not have "more" complications than Gastric Bypass but if complications occur, the complications are greater in nature.

By the time you have this procedure you will not absorb 80% of fat, 50% of protein, and a handful of complex carbs. A high fat diet is not only permissible with this surgery type, it is necessary.

One down side to this surgery types more-so than other surgery types is that if you consume a great deal of white carbs such as flour, sugar, rice, or pasta you will have gas that is not pleasant to the nose. This happens with RNY as well but not to the same degree.

Not all surgeons can do this surgery type. It requires a skill as well as an art, much experience is necessary to perform this particular surgery safely and effectively. For detailed information please see the following website:

www.DSFacts.com

They can do this surgery type far more justice than I can.

Three advantages of this surgery:

1) Best weight loss and best long term weight loss stats of all surgery types
2) Not only the ability but the necessity for the patient to consume a very high fat, high protein, low carb diet
3) A more normal stomach than bypass, there is no pouch and no stoma

Three disadvantages of this surgery:

1) Highest risk surgery type
2) Highest risk for vitamin and mineral deficiencies
3) Not appropriate for vegetarians or vegans or those unable to comply with a high fat diet

There is another procedure type, it is one I cannot suggest to anyone for any reason:

MINI GASTRIC BYPASS aka MGB

This was the original bypass procedure and due to bile leaking into the stomach and esophagus (causing SEVERE burns) ALL the better surgeons stopped doing it in the 1970s. It is merely dangerous and only the bottom-feeder surgeons even do this procedure. It is technically easier to do than RNY or full gastric bypass but due to the danger to the patient none of the skilled doctors with good reputations will do it.

GASTRIC SLEEVE PLICATION aka GASTRIC IMBLICATION, aka Plication

This is a new procedure, as of this writing the best long term stats are only 18 months old. It is similar to a sleeve but instead of stapling and removing tissue it requires sutures instead to create a sleeve shape. No part of the fundus is removed.

It is restrictive only and not malabsorptive.

Three advantages of this surgery:

1) No risk of a staple line leak however, there can still be a leak from perforating the stomach.

2) There is no tissue removed (This creeps out some people who are considering the sleeve.)

3) It is done by lap instead of full open incision surgery.

Three disadvantages:

1) It will be extremely difficult to revise to anything else but DS if it does not work and it is unknown if it will work because there are no long term stats available.

2) Reflux is much more significant for this surgery type vs. the sleeve. Unfortunately, there is little to do to resolve this if meds (PPIs) do not help.

3) The sutures can give way over time and the stomach would be larger thus the person could eat more. Speaking of sutures one of the dangerous aspects of this surgery is the blood supply in the stomach. The stomach has a rich blood supply and many large blood vessels on the left side of the stomach. When the plicated stomach is folded in and sutured it can potentially cut off the blood supply and the stomach tissue will die and become necrotic. This can happen immediately post op or months down the road.

****NOTE NOTE NOTE****

8/17/11

As of this writing the doctor who originally created this surgical procedure was at a Germany Bariatric Conference within the last week and he strongly advises physicians to explain this procedure is a temporary weight loss procedure that is not expected to give long term results. It is sill investigational and his own 3 year stats show significant regain at the 3 year point post op. The creator of this surgical type does not suggest this surgery for long term weight loss.

VERGITO

More info and animation coming soon. If you want to see an animation of the procedure please visit Dr. Husted's website, he is the only surgeon in the US that does this procedure: http://johnhustedmd.com/

Now it is your job to determine which surgery type is right for you. First you consider if you want restrictive only (Bands/Sleeves) or if you want Restriction AND malabsorption (Bypass/DS). The greater the risk the better the weight loss and long term regain stats. It's a trade off, whatever you think is right for you.

Remember, if a doctor can only afford to advertise on www.youtube.com, it might behoove you to look elsewhere for a more skilled surgeon.

Fat Folks Are Wise Folks

2010-03-24T20:42:00.000-07:00

I have a dream.

You see, I am in medicine and I have been working with all kinds of patients for more years than I can to admit. Anyone in medicine, a policeman, or a fireman... they can all tell you that they live vicariously through their patients/prisoners. We don't always have to have a disease, go through an experience, or do something stupid to learn. We can learn through others. I am convinced that retired nurses are bored to tears, they are no longer living life through others. They need the challenge and the lessons. I remember walking into a room of seriously mentally ill folks and "feeling" what they were feeling and to be quite frank, it scared the hell out of me. I could zone into the person I was connecting with. I got it, I understood. I didn't like it - not even a little. I would never want to experience that for the rest of my life. But, I did have the opportunity to experience it for a few moments.

A friend of mine is a nurse and she still relates a story from her own "care home" days. She had a mentally ill young patient that was bare butt nek'ed on the front lawn on her hands and knees mooing like a cow. Now seriously, how many of us have seen such a sight? I had a patient that drank so much water (it's called water intoxication syndrome) that he aspirated the contents of his stomach and drowned in his own water. He died at 31. I had another mentally ill patient that probably taught me more than I'll ever know in my whole lifetime with her one experience. She was a paranoid schizophrenic. I was working late one evening in my office and I heard some strange noises and left the safety of my office to see what the noises were. It was Margene, my patient. She was outside, curled up in a fetal position rocking back and forth making primitive noises. I sat down on the ground with her and asked her what was wrong? Was she in pain? She said she had just been gang raped. The reality was that she had not been gang raped on a pool table (we had no pool table) but the voices she heard 24/7 convinced her she had. It was that moment that I realized just how real these voices she heard were. She *believed* she had been gang raped and she was going through all the emotions that someone who really had been gang raped would go through. It was that moment that I realized, I get it. I really get it.

Obesity is not really a lot different in terms of lessons. We learn things we would never learn otherwise. Obesity isn't such a bad thing. STAYING obese is a very bad thing but going through the weight loss journey... not so bad. Sure, it's hard. But we learn things we wouldn't "get" otherwise. If someone would have told me this before I got to goal - I would have laughed at them and told them they didn't have a clue. It wasn't until I got to goal that I really fully understood. It IS worth it. If we are on this earth for nothing else it is to learn and you can't help but to learn as a fat person getting to goal. You learn about yourself and more important, you learn about the world around you. You learn about the issues of others. You "get" it, you really really do! Lessons you could not possibly learn through another, you learn through your own experiences.

I have a dream. My dream is to be a little old lady sitting in my rocking chair clicking my nails on the arm rest while on my front porch. You see, all the little neighborhood children will come to my front porch and hear my really cool stories. Everything, everything from my career to the ability to have a kind of compassion for people I would have never had, had I not been fat at one time.

It's not all bad. Obesity is a disease - it's not a character flaw. We learn to fix our disease. We learn from our disease. California beach blondes twirling their hair and rolling their eyes at us fatties... they will never get it. They will die uneducated. We are a different group, we will die a compassionate and intelligent group of people.

Finding a Surgeon - How?

2010-03-23T15:22:00.000-07:00

There is just so much to write here. So much!

If your insurance is paying for your surgery the first thing is to determine your surgery type. The second thing to do is to find out who your insurance company contracts with and get that list. Go to every seminar for every doctor. Avoid the band mill type places, find a doctor that does all the major surgery types. If you want Gastric Bypass and you go to a surgeon that only does lap bands do you really think that doctor is going to try and sell you bypass? Of course not.

Doctors put on seminars for one reason and one reason only. To sell themselves to patients. They are not doing these seminars for your benefit, it is a method to give the same lecture to a group of people. It's a method of advertising. The doctor is selling his service, in this case Weight Loss Surgery. He is not going to use an expensive mode such as a seminar to talk you into going to one of his competitors.

Doctors are in business to earn a buck, that's okay. That is the profession they chose just like you chose the profession you practice. There is no rule that says a doctor cannot earn his living practicing his trade. But the bottom line is it is still a business and run like a business. The doctor is just like the car dealer, a Toyota dealer is not going to encourage you to buy a car they do not make, they are going to encourage you to buy a Toyota. A Band doctor is not going to talk you into Gastric Bypass if he does not do Gastric Bypass. He is going to emphasize all the good parts of the surgery he does do and brush off the procedures he does not do. You would do the same in his shoes.

This is why you choose a surgery type first and then you choose a surgeon. YOU are the person that has to live with this surgery type for the rest of your life, make it the right surgery type for you, not the surgery type that is in the best interest of your doctor's bank account.

So you have insurance (those without insurance or without WLS benefits on their insurance plan will be discussed further down.) and you need to find a surgeon. You have picked out your surgery type and you have a list of the doctors that contract with your insurance plan. You have ruled out the doctors that do not do your surgery type and you have gone to their seminars.

Do you need to *like* your surgeon or is it more important that his surgical skill is tops? Well, the answer to that is both. There are so many surgeons out there that want a piece of the bariatric money pie that there is little need to go to someone that is really nice but lacks in experience or skill. There is also little need to go to someone that is great in surgery but is a butt in his office. You have a right to both. The reason you want a skilled and experienced surgeon that is someone you like and respect as a human being is because if you have any other surgery type than a sleeve, you will be getting to know your surgeon well. All surgery types except sleeves require a lifetime of aftercare. Bands need fills and various check ups, Bypass and DS need labs for life. Now, with that said many bypass and DS folks do have their PCP do annual labs but if those labs are not up to par it is typically the bariatric surgeon that changes the vitamin regimen. If you do not like your surgeon you are not likely to go for follow up appointments and you are not likely to be honest about concerns and medical problems, weight loss or weight gain. So it really is important to find a surgeon you can be honest with, share personal thoughts and feelings, and overall just someone you feel comfortable with.

NO BARIATRIC COVERAGE ON YOUR INSURANCE PLAN OR NO INSURANCE AT ALL

Welcome to my world, the world of self pay.

Most people do not have WLS coverage even if they do have insurance. Most have insurance through an employer and it is the employer that needs to pay an additional premium on top of major medical for WLS benefits. With the economy today people are lucky to have basic insurance. Employers are saving money anywhere they can and sadly, that includes WLS premiums. It is not the insurance company that isn't offering it for group plans, it is the employer who can't pay the expensive premiums.

Private policies typically do not cover WLS for reasons explained earlier. So the bottom line is that we have a lot of people that have no insurance or they have insurance and no WLS benefits. They are self pay. If they do not have access to Medicaid or Medicare, and their insurance does not pay they are left with self pay. The downside to that is they are self pay, the upside to this is that they can virtually go to any surgeon they want and - in any country. I'll discuss that later in a section for Medical Tourism. But for now we are looking at US surgeons.

So you now have decided on a surgery type, you have obtained a list of all the bariatric surgeons on your insurance plan, you have ruled out all those who do not do your surgery type, and you have been to their seminars. You have ruled out those that give you the heebie jeebies, those that are so arrogant that you can't stand being in the same room as they are, doctors that do not answer questions in a way that makes you feel like you are walking away with more knowledge than you walked in there with, and you have narrowed your list further. Now what?

Now you start your research.

Sit down and make a list of things you require of your doctor and a list of things that you prefer in a doctor. For example, it might be something like this:

I require from my doctor:

1) FACS affiliation
2) ASMBS affiliation
3) A minimum of 500 (name your surgery type) procedures
4) A hospital instead of an outpatient surgical center
5) An office staff I can deal with and tolerate
6) (List your requirements)

I PREFER my doctor have:

1) A location reasonably close to my home (depending on surgery type this may or may not be possible.)
2) A nutritionist on staff vs. at a different location
3) A psychologist on staff vs. at a different location
4) ALL aftercare included in the cost of surgery (Get this in writing)
5) Support groups held weekly/monthly
6) (List your preferences)

This allows you to narrow the list down further.

Myth Or Fact?

All doctors are ethical and would never lie about affiliations? What do you think?

It is a MYTH. Many doctors will claim affiliations they do not really have. In order to be FACS one must meet very specific requirements. Many doctors will claim this affiliation but it's not true, they keep the affiliation until www.FACS.org catches them and requires they remove these letters from the end of their name. ASMBS is the same.

Doctors also claim that they have performed many more surgeries than they really have. This one is very hard to verify one way or another. I know of one Las Vegas surgeon that claims hundreds and hundreds of sleeves but as of today's date he has done a grand total of "3" sleeves. Yes, three. Yet when you call his office the staff will claim hundreds and hundreds of sleeves AND this doctor is a Center of Excellence. Scary, right? It is scary.

MYTH OR FACT?

You cannot verify all doctors for FACS or ASMBS affiliation.

MYTH. You most certainly can verify this information.

www.FACS.org

And:

www.ASMBS.org

Just go to the websites and do a search of your doctor, verify what you are being told is truth.

Please remember, the doctor will have a coordinator. It is his/her job to sell you surgery after the seminar. Sometimes they will tell you anything you want to hear just to sell you surgery. Yes, they will lie.

The bottom line here really is to know how to verify what you are told and NOT to believe everything you are told just because it comes from the MD office.

You should also get about 10 references for these doctors. Notice, I did not say you should get references FROM these doctors, I wrote to get them FOR these doctors. If you ask the office staff for 10 references you know full well they are going to give you patients that are thrilled to death and never had a problem. You need to find your own references. Go on various boards, find people that tend to be a bit quiet and shy. You see, there are a LOT of patient coordinators posing as patients on various message boards trying to recruit patients to their offices. There are not many doctors that use this method, but they are pretty easy to find. They invite each person to go to their doctor, only their doctor is the best, they cannot suggest anyone else in the whole wide world other than their doctor. Stay away from those folks. Find people that suggest several doctors, people that the majority of their posts are NOT about their doctor. Contact them and ask if you can talk to them on the phone.

There is a reason I suggest you talk to them on the phone. I recall when I was researching for my own surgery, one of the doctor's offices that I called I requested 10 references. They gave them to me and I contacted each one by email. All had wonderful things to say about the doctor. Real or fake? Fake. Upon looking at the IP address for all 10 references it was the same. It was the same person with 10 email addresses.

I'm telling you, the world of bariatrics is a cut throat business and you really can't be too careful. This IS your health, your life, and your future, take the time to do the legwork. Be paranoid, assume everything you are being told is a lie. Verify everything for yourself and take nobody at their word. These are businesses trying to survive in a bad economy, it's not just used car salesmen that are less than honest, it's many people and many businesses.

Does this mean every doctor will lie to you? Of course not, most will not lie. But the key here is that YOU do not know which are telling the truth and which are lying.

What about a death stat? What if a doctor has had a death? Does that mean he is a butcher that you should stay away from? Of course not. Not all deaths are the fault of the surgeon. Some people are *really* high risk and without surgery they will die. With surgery they are extremely high risk. What does a surgeon do? Refuse them a chance? Or take the chance?

Not all complications are the fault of the surgeon. A surgeon can give all the right pre op drugs to prevent blood clots but there is no promise that the body won't throw one anyway. Is that the fault of the surgeon or is that something that is sad but it happens?

What about leak stats? If a surgeon has had a leak does that make him a horrible surgeon? Not necessarily. Some leaks are the fault of the surgeon, some are the fault of the patient, and some are not the fault of anyone, they just happen. So what you are looking for are trends. Does this doctor have a ton of leaks? Higher than the average of less than 1%? There is a learning curve to every surgery type. Your doctor has to go through the learning curve just like everyone else. Make sure you are not his learning curve.

I will post an article on Researching Mexican LAP BAND surgeons as well as one on Researching Mexican SLEEVE surgeons. These articles will help you regardless if you are staying in the US and having surgery under insurance, self pay, OR if you are leaving the country for surgery.

Researching A Mexican Or US Sleeve OR Gastric Bypass Surgeon

2010-03-22T17:21:00.000-07:00

RESEARCHING A MEXICAN OR US SLEEVE SURGEON 101

Getting a Vertical Sleeve Gastrectomy/Sleeve Procedure

***It has come to my attention that there is a man in Tijuana, Mexico that is posing as a physician, not a surgeon and no - he is not doing surgery he merely owns the clinic. This man is posing as a physician and he is not a physician. He has never been to medical school, he has no formal medical education. ANYONE that claims to be a physician or surgeon you should verify this through the Mexican Government. You need to obtain the license number of the physician and enter it to the following website. The true owner of the license will show up. There is absolutely no reason any licensed physician would deny you their license number, none!***

This will work for MX or US surgeons. Perhaps someday I will list links for each US state to verify if your US surgeon is Board certified in surgery.

Start with the medical licensing board/bureau in your state. There you can see if the doctor's license is current and in good standing. You can see if the doctor has had any disciplinary action taken against him/her in recent years. In many states, you can see where the doctor went to medical school and how long he/she has been licensed to practice in your state.

Google is also a good tool. Type in your doctor's name and state to see what comes up. Then type in your doctor's name and one of these key search words:

Lawsuits
Malpractice
Complaints
Disciplinary action
Court
Reviews

For Mexican surgeons the link is:

http://www.cmcgac.org.mx/cgi-bin/DirectorioMedicos

To see if that surgeon is a member of the Mexican College of Bariatric Surgeons use this link:

http://www.cmco.org.mx/?q=contact

To verify that a doctor in Mexico is a licensed physician you need his license number and you enter it on this website and it will tell you who the license belongs to:

http://www.cedulaprofesional.sep.gob.mx:7057/cedula/CntConsultaVisitas

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 Welcome to the American College of Surgeons and obtain the (800) number from their website and call. Ask them if it is true the doctor you are researching is indeed a Fellow. You can search on their website but their website is often times hard to navigate. It's easier to call them and obtain the information over the phone.

Please note: There are doctors that claim to be FACS and they are not. They are banking that you will not verify this information. Do not take the office staff or MD's word for it that they are FaCS, go to their website and verify for yourself. That website is:

www.FACS.org

If you are unsure call the (800) and ask the FACS staff, they will assist you.

Experience

How long has your doctor been doing sleeves? No, not how long he has been doing bariatric surgery but how long he's been doing sleeves? That is the question you want to ask. Someone can do 4000 lap procedures but that does not mean he has done 4000 sleeves. A doctor can do 4000 lap procedures and they might all be Lap Bands or removing someone's gallbladder. That is not what we are looking for; we are looking for someone very experienced in sleeve issues. We have different needs and requirements than folks who had a Lap Band and the technique is extremely different for various procedures. There is a learning curve to each procedure, and with each procedure the doctors 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?

Many make the mistake of thinking that they really "like" their doctor and they bank on personality instead of skill. This is a major mistake.

Find someone who has done *at least* 250 sleeves AND 250 Gastric Bypass procedures. The Bypass staple line is quite difficult to do and not everyone can do it. It can't be over sewn or secured so it takes great skill to do this type of staple line. If someone can do a bypass staple line without problems then they should be fine with a sleeve staple line. If they can't do a difficult bypass staple line then do you want them doing any staple line on you?

Skill

We should discuss skill. Banding is the easiest surgical bariatric procedure to do. Yes, there is a learning curve; however, after the learning curve it is without a doubt the easiest procedure to do. That is why so many new doctors what a piece of the action. After they do a few bands they decide to start getting into the trickier procedures such as bypass and sleeves.

Can your potential doctor do the hard stuff too? Can they do gastric bypass? Duodenal switch (DS)? Can they do revisions such as bypass to banding? Many bypass procedures fail and the patient regains their weight. Band after bypass 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 doctors do not do all the tricky procedures, they just don't have the training, skill, or experience so they stick with less complicated procedures. My personal preference is to have someone that can do it all, even the difficult and tricky procedures. Some don't care, they just want a sleeve 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 sleeves has a doctor really done? I know of one in Mexico that has done less than 200-300 sleeves, yet he claims astronomical numbers on his website. Doctors 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 100 sleeves 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 300 bands and 300 sleeves yet his partner has done over 5000 bands and over 500 sleeves so he claims he has done 1300 bands and 600 sleeves. It simply isn't true.

So read the discussion boards and 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 on various message boards that you are looking for a sleeve surgeon, the patient coordinators are going to come out posting nonstop. These are people that are paid to get you to go to their employer. Some of them have been sleeved 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 from 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, they are probably a coordinator. For example, 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 online. 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 sleeves, everything. It takes many years to build a practice, it does not happen overnight. The practice, the reputation, the works, it takes years. Now keep in mind, this is after they are experienced, established, and have a great reputation. Doctors in Mexico depend on reputation, they do not have insurance companies sending them patients, they have no choice but to do a good job and build their reputation. It happens much more slowly in Mexico (building a reputation) than it does in the US. After someone has been I practice for about 5-7 years, then their procedure stats will start climbing. If someone has been in practice for 2-3 years and claiming big numbers, you know they are making up stories.

Booking Agencies/Medical Tourism Companies

This is another area of consideration. Do you want to deal with a booking agency? Some do, some do not. It comes down to personal preference. Booking agencies are paid to advertise for several doctors, 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. This usually tacks on about $1500 to your surgery price. This is why I suggest going to the surgeons office directly, you can call the office and schedule surgery yourself and save $1500.00. 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. I have yet to see a sincerely ethical medical tourism company. The greater majority of the time they have never even met the surgeon, if he is cheap, owns his own scalpel, and can sign his name on the contract, he's hired. While it is personal choice, please just go through the surgeon's office. YOU find the surgeon, don't depend on someone to choose your surgeon based on the amount of commission they will make. They are going to choose the cheapest surgeon because then they can charge you a bigger commission.

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.

That brings up the topic of which border city. Some are quite safe; some are the most dangerous cities in Mexico. Know where you are going. If there are police officers and army stationed all over with large guns, you might not be in a great city. Mexico has problems with their border towns just like we do in the US.

Hospital or clinic?

There is no way that it is safe to have a sleeve procedure or any WLS surgery in a clinic in Mexico. This is a procedure that carries a bit more risk than other procedures and you really need to be in a hospital. Obese 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 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, it could be hours. The risk for sleeve complications is quite low but it does happen. If it did happen I wanted to already be in a hospital.

One problem with going to Mexico is that most doctors refer to their clinics as hospitals. They refer to a surgical center as a hospital. When you call ask if the "hospital" has a pharmacy, blood bank, ICU, Pediatric ICU, Heart center, specialist available 24/7 such as cardiologists, etc. Ask them if they have a fully equipped radiology department with fluoroscopy, CT equipment, and equipment that would be found in a hospital but not a clinic. If they do not have all this equipment available it is a clinic and not a hospital and they are trying to fool you into thinking they are something they are not.

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 the cost of the staples used on your stomach are far more expensive than you might realize. The cost of the staples alone could very easily be between $2,000 and $3,000 per patient. That is the doctor's cost on that one supply needed during surgery. 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, this is one way to research your doctor. If there are not, that might be a problem. See what the trends are. There will always be patients that no matter what is done they will never be happy so if there are 1% of testimonials that are not great, look at the overall picture. If people are happy they will say so if they are taking the time to write a testimonial. Just make sure to read the opinions of a LOT of patients and not just a few.

Talking to people online is a great way to get an idea of doctors. 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 50 patient testimonials or talk to at least 50 people about their surgery.

There are four doctors 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 surgery 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, and all she did. She went to the same doctor and ended up with an infection so severe she will lose her Lap Band. I know of two others who went to the same doctor, one for a sleeve and one for DS and both almost died. Had they stayed in that facility a day longer vs. leaving the "clinic" against medical advice, they would have died. It happens all the time and it is not just Mexican doctors that cause infections, it happens in the US. You are not going to all the expense and trouble to have surgery just to lose your health and potentially your life to an unskilled surgeon. Do your research.

Mexico struggles with the same issues as the US in dealing with the bad doctors. People believe that having surgery in the US is safe because it is the US. Not true. In my own city there is a convicted pedophile currently licensed as a pediatrician. I know of three surgeons in my city who were caught intoxicated while operating on their patients, they all received a "Letter of Concern," in their files. That is less than a slap on the hands. Mexico is no different from the US in this case, it is important to research your doctor regardless of which country you are in.

Pre-Op Testing

This is critical to have a safe surgery. You should get AT LEAST a complete blood count, chemistry panel, thyroid profile, 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 do 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 surgery 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

Regarding sleeve procedures there should typically be three tests. They are all leak tests. One isn't really a "post op" leak test, it is a leak test done during surgery. The doctor will fill your stomach with air, fill your abdominal cavity with saline and look for bubbles.

Leak test #2: Methylene Blue. You will have a drain in your incision; they will have you drink a product called Methylene Blue. It looks exactly like blue ink. Your tongue will even turn blue for a few hours after you drink it. The idea is to see if anything blue comes out of your drain.

Leak test #3: Contrast under fluoroscopy. You will drink a product that shows up under fluoroscopy. Fluoroscopy is a moving x-ray and it is critical to have all three of these leak tests before returning to your home. This test will check for micro perforations or tiny "pinhole" leaks that may not show up otherwise.

A very important question for you to ask when researching your surgeon is if the contrast material they will use during your fluoroscopy leak test is barium or a 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.

Researching A Mexican Or US Lap Band Surgeon

2010-03-21T16:58:00.000-07:00

I wrote this a long time ago on a message board and I am reposting here with some edits and additions. Mostly I am adding a few links such as how to verify a surgeon is Board Certified in Surgery and that sort of information.

This will work for MX or US surgeons. Perhaps someday I will list links for each US state to verify if your US surgeon is Board certified in surgery.

Start with the medical licensing board/bureau in your state. There you can see if the doctor's license is current and in good standing. You can see if the doctor has had any disciplinary action taken against him/her in recent years. In many states, you can see where the doctor went to medical school and how long he/she has been licensed to practice in your state.

Google is also a good tool. Type in your doctor's name and state to see what comes up. Then type in your doctor's name and one of these key search words:

Lawsuits
Malpractice
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For Mexican surgeons the link is:

http://www.cmcgac.org.mx/cgi-bin/DirectorioMedicos

To see if that surgeon is a member of the Mexican College of Bariatric Surgeons use this link:

http://www.cmco.org.mx/?q=contact

To verify that a doctor in Mexico is a licensed physician you need his license number and you enter it on this website and it will tell you who the license belongs to:

http://www.cedulaprofesional.sep.gob.mx:7057/cedula/CntConsultaVisitas

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.

RESEARCHING MEXICAN LAP BAND 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 www.obesityhelp.com and research your doctor. OH makes it very difficult to research Mexican surgeons, they make it quite simple to research US surgeons. For Mexican surgeons you need to research by specific name vs. US surgeons you can research by geographical location. There should be plenty of patient testimonials. If there are not, that might be a problem. See what the trends are. There will always be patients that no matter what is done they will never be happy so if there are 0.001% of testimonials that are not great, look at the overall picture. If people are happy they will say so if they are taking the time to write a testimonial. Just make sure to read the opinions of a LOT of patients and not just a few.

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.obesityhelp.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.

Helpful Links For WLS Folks

2010-03-20T19:48:00.000-07:00

Here are some links, all kinds of links. I am sorry they are not in link version but for some reason the software will not let me make them into links so you'll have to copy and paste to your browser before they will work.

Please please bookmark this site, this is a site that updates all the studies being done on obesity today. Read daily and keep up to date on the new science behind obesity, I will attempt to add an RSS feeder to this blog if you prefer to read the studies here:

http://www.medicalnewstoday.com/sections/fitness-obesity/

This is the same as the above only on nutrition:

http://www.medicalnewstoday.com/sections/nutrition-agriculture/

The following link is merely out of respect, a very dear banded friend of mine passed away from esophageal cancer, nothing in the world to do with her WLS. But out of respect I would like to post her blog:

http://www.scentednectar.com/sneerfactor/

A McDonalds Hamburger - This will show you that Mickey D's is not food, I don't know what it is but it is not food:

http://www.youtube.com/watch?v=4IGtDPG4UfI&feature=channel_page

A friend of mine started a WLS forum, he couldn't make a go of it but he let me take it over and we use it for chit chat. The mods there are me, Elisabethsew from LBT and VST, and MacMadame from OH:

www.wlsfacts.com

Calculate your BMI:

http://nhlbisupport.com/bmi/bmicalc.htm

Calculate your BMR:

http://www.bmi-calculator.net/bmr-calculator/

Why do some of us lose hair after surgery? Here is the explanation:

http://emedicine.medscape.com/article/1071566-overview

This is a recipe forum where you enter the ingredients you have and then you can find recipes for what you already have in your house:

http://emedicine.medscape.com/article/1071566-overview

American College of Surgeons:

www.FACS.org

American Society for Metabolic & Bariatric Surgery:

www.ASMBS.org

5 Day Pouch Test:

http://www.5daypouchtest.com/

My Favorite place to buy protein products and various supplies:

www.netrition.com

A great source to tell you everything you ever wanted to know about specific food items. You can enter a recipe here and it will make a complete food label for your entire recipe:

www.nutritiondata.com

Some sites to track your food and weight:

www.TheDailyPlate.com

www.FitDay.com

www.SparkPeople.com

A US Government Website where you can find various clinical trials:

http://clinicaltrials.gov/

This study changed the way the world of medicine looks at diabetes:

http://www.medicalnewstoday.com/articles/72982.php

Here is a detailed weight graph for those of us who obsess over weight (However, I use www.TheDailyPlate.com):

http://www.thinnerself.com/files/Expect_Chart.htm

The Scoop on Poop, things change, colors change, this explains your pooh:

http://www.heptune.com/poop.html

Why TUMS and Rolaids are not great for reflux symptoms:

http://ezinearticles.com/?Acid-Rebound,-Acid-Reflux-And-Your-Health&id=761343

What is Ghrelin?

http://www.wisegeek.com/what-is-ghrelin.htm

Surgery types explained:

http://www.asbs.org/html/patients/gastroplasty.html

Vit D Council (you can order a test kit to test your own Vit D levels here):

http://www.vitamindcouncil.org/

Gastric Emptying explained:

http://www.vivo.colostate.edu/hbooks/pathphys/digestion/stomach/emptying.html

Information on obtaining a passport if you choose to leave the country for surgery:

http://travel.state.gov/passport/get/fees/fees_837.html

What will you look like as you lose weight? Upload your photo and see!

http://www0.weightmirror.com/weightmirror/index.php?id

Comparing RNY and DS;

http://www.dsfacts.com/Comparison-of-DS-and-RNY.html

Weight Loss Plateaus explained:

http://www.weightwatchers.com/util/art/index_art.aspx?tabnum=1&art_id=23561

Bariatric Revision surgery video:

http://www.orlive.com/ethiconendo-surgery/videos/bariatric-revision-surgery?cmpid=ens_2539_adwords&gclid=CMnur9_ZqZ8CFRwTagodJTcW0w

Insurance Hoops - Surviving the Insanity!

2010-03-19T13:36:00.000-07:00

Congratulations! You are ready to have surgery. You have decided on a surgery type, you have picked your surgeon, now comes the insurance hoops to jump though for those going through insurance.

Some insurance companies offer limited surgery types. Some will only pay for bands and bypass. Some will only pay for sleeves or DS if your BMI is over 50. What if you want a sleeve and your insurance will only pay for bands and bypass?

APPEAL APPEAL APPEAL!

It isn't a sure bet that your insurance will approve an appeal but what do you have to lose?

Now, every insurance company I have looked into and researched require a BMI of 40 or greater to be approved for weight loss surgery. Most will accept your 35 BMI *if* you have very specific comorbidities. Typically they want to see active high blood pressure, diabetes, sleep apnea, and/or a history of heart disease. Although we have a poor quality of life with back pain, joint damage, an inability to breathe well, borderline high blood pressure, pre diabetes, asthma... those just don't count. They are typically very specific which cormorbidities they require for a BMI of 35 - 39.9.

What if you have high blood pressure but it is controlled with diet alone? No, it does not usually count.

What if you are pre-diabetic? No, it does not usually count.

What if you have a family history of strokes, diabetes, high blood pressure, and/or sleep apnea? No, that does not count.

You have to be actively treated for these things by a doctor with medications and such before the insurance company will consider them comorbidities. Remember, insurance companies are not strong in common sense. You have to think like them to understand them. Yes, they would prefer to pay for your heart attacks, dialysis, and other related expenses than to pay for your weight loss surgery if it is something they do not cover. They act like a computer, computers do not think, they just spit out information. Computers follow rules, they have no common sense. They don't look at the best value for a dollar spent. Information in, information out. That is exactly what an insurance company does. Some people write long letters to the insurance company begging and pleading for coverage when they do not qualify for some reason. It does not matter. The insurance company (think computer) does not care about you as a human being that is sick and miserable. They care if your blood pressure is high enough and if you are obese enough. If the numbers add up they will pay for your surgery. I know it is not right and it is not ethical, but this is how it works so you will do better for yourself to accept this is how it works and approach it from the right angle. No, life is not fair and no, it is not right but they call the shots and they usually get to have their own way.

What if you want DS but your insurance pays for bypass or bands? Many think if they need NSAIDs (Aspirin, Naprosyn, Motrin, etc.) they can appeal based on this since you cannot take NSAIDs with bypass. They will likely deny you because they do offer bands and you can take NSAIDs with bands. (History: It used to be that doctors thought NSAIDs could not be taken by band patients due to causing erosion, that has since been shown to be inaccurate, NSAIDs do not cause erosion in banded people.)

I recall one person that was just sure he could get a non-covered sleeve on appeal based on the fact that he is deficient in Vitamin D. That is a no-go as well. Most of the US population is low on Vitamin D. Supplements will bring it up and therefore if they cover bands and bypass, they are good to go. Keeping in mind that many times the number of times you may appeal are limited, don't waste your appeals on what you know isn't going to work.

What if you weigh 900# and you have no benefits for WLS? You are out of luck. Yes, once again the insurance companies would rather pay the hundreds of thousands of dollars to treat what weight loss surgery would fix.

Many (most?) insurance companies will not pay for sleeves. They consider the procedure to be investigational. The ASMBS disagrees and they no longer consider the procedure investigational. Let's realize one issue here, the sleeve is not new! The weight loss stats are new, not the surgery itself. With some insurance companies - some of the time - you can appeal and get a sleeve by proving it is not investigational. Once Medicare starts paying for sleeves then you will see more insurance companies beginning to follow suit as well.

What if they require a medically supervised diet for 3-6 months? How does that work?

It really depends on the wording of the insurance company. If they want a "medically supervised" diet they want you going to your doctor and/or nutritionist monthly. They want documentation of effort on your part to try and change eating behaviors, exercise, and sometimes psych care to treat a "medical" problem of obesity. (I know, that doesn't usually make sense either, it's like going to your psych for your diabetes!) They want to make sure that every 25-30 days you have been to your appointments. Not 32 days but 30 days. They want your medical provider to document your weight, the change in weight from the previous month, and written data showing they worked with you on diet and exercise.

If they do not specify "Medically Supervised" then they probably mean something like Weight Watchers, Jenny Craig, some sort of proof that you tried and participated for 6 months. Ask your insurance company and if your policy is not clear make them put it in writing.

What if your insurance company wants proof that you have been a specific BMI or greater for the last five years? If you are anything like most, most of us have dodged doctor's scales for years. It might not be in your medical records what your weight was so be creative! What does your weight say on your drivers license? Okay, if you are like most you are at or near your heaviest today but you still show 150# on your license. But, if you told the truth on your license and it shows your BMI is what is required, that can be put toward proof for that year.

Photographs! Some photos are dated by an outside source (other than your digital camera) such as Walgreen's Photo Dept. If it is obvious from dated photos that you met the BMI requirements, that can often times be used as well.

Emergency Room visits - think back to anytime you might have needed to go to the hospital for sutures or a broken bone. They usually insist on weighing you. Those records can be used to prove BMI requirements.

Be creative and find whatever is necessary to prove your BMI if you do not have proof at your MD office.

What if you lose weight on the supervised diet and fall below the required BMI? You are safe. If you met all the BMI requirements in the beginning of the insurance approval process it is okay if you fall below on the required diet. Can you imagine the lawsuits otherwise? They require you to lose weight to prove your mind is made up and this is what you want then they deny you because you did exactly as you were instructed. Lose weight on your pre op diet, it's safer for you at the time of surgery.

Usually you have to meet other requirements that are equally silly to have insurance pay for your weight loss surgery. They want you to go to a bariatric surgeon for an eval. They may want you to see a psychologist to see if you are mentally prepared for surgery, this is just an eval and not an on-going therapy process. If they suggest you need therapy before surgery ask if you are required to go to them for your therapy before they will approve you. It *might* be a way to force you to continue going back for sessions just to pad their pockets. This does not happen often but it does happen. If you want you can always get a 2nd opinion.

They want you to do a sleep study to see if you have Sleep Apnea and this is something weight loss is likely to fix anyway. They want you to see a nutritionist for an eval prior to surgery. This one annoys me as most nutritionists do not have a huge base of knowledge on weight loss surgery. They will tell people to eat far more calories than possible after surgery. All surgery types limit quantity of food. Just how are you supposed to eat 1800 calories a day with a stomach the size of a ping pong ball? Top that off with their instructions NOT to drink your calories and you see my point. They have more training in people that have specific medical conditions such as wheat allergies, need a gluten free diet, etc. Sometimes they may not understand our issues. If you can go to a nutritionist that is also a WLS patient, all the better.

Many nutritionists will give you a diet for bypass but if you have other surgery types, it doesn't work. For example, DS patients NEED and REQUIRE a very high fat diet but their instructions are likely to stay on a low fat diet. DS folks malabsorb 80% of their fat intake and to keep losing weight they absolutely must eat a high fat diet. I can give you many examples but my advice to you is to ask for a combination of what you should eat. What percentage of your daily food should be carbs, protein, and fat? Listen to your doctor and not your NUT (nutritionist) about caloric requirements. Ask how many grams of protein you should be consuming daily. But again, ask your doctor about caloric requirements.

Dealing with insurance companies is no easy task. Some insurance companies are easier to deal with than others. If all else fails, have your surgeon do a peer to peer review with them. That means your surgeons sets an appointment with the doctor at your insurance company and he explains why you must have "X" surgery type instead of what they say they will pay for.

**NOTE: Regarding peer to peer reviews, this is a LAST option. Do not use this for your 1st or 2nd appeal or you *will* be denied. Insurance companies do not want their doctor tied up doing what the appeals department should be doing. So use it as a last and final option.

If that fails you have one more option. Seek the advice of an attorney. There is one attorney that does nothing but this type of work. It seems somewhat affordable and they appear to have a good track record. I prefer not to advertise specific businesses that I have no personal experience with but you can go to www.obesityhelp.com and post most anywhere asking for this man's name and you will get your answer. I would not suggest contacting your family attorney as he does not likely specialize in this and he doesn't know the ins and outs of insurance companies and weight loss surgery. It may end up being far more expensive going through your own attorney just because he may need to take more steps and charge you for each step until he finds the correct appeal paperwork. But clearly, this is your choice.

Why Do We Kill Ourselves With Food? Evil Head Stuff!

2010-03-18T14:35:00.000-07:00

I think this is a question we all ask at one time or another. Why DO we do it?

Most newbies firmly believe we eat this way because of a food addiction. I don't know, perhaps that is true. I think as a post op weight loss surgery patient when we come across times when we turn to food and we can no longer eat the way we used to it is a bit of a wake up call. Perhaps someone makes you very angry and you pull out that extra yummy something you pretend you forgot about in the freezer and you start munching. After your very few bites nothing more will fit in that ping pong ball size stomach you have as a newbie post op and you realize - you aren't done. You are not physically hungry, matter of fact you are pretty darn full but you want more food anyway. What's up with that?

Or maybe you are stressed, your boss screamed at you today and if anyone cared to know the truth your boss is a putz and does not have a clue what he is doing. You turn to food and guess what? You eat your few bites of food and you are too full to eat more but you want more anyway.

Some people deal with emotions by eating. At the time we are eating the scary fats and carbs we justify it:

~I had a REALLY bad day today and I just do not care!

~My boss is an idiot, everyone knows it but nobody does anything about it!

~I do not feel well, everyone knows you feed a cold - or do you?

~I am depressed, I deserve a little treat!

~I already screwed up today with carbs so I'll get back on track tomorrow. Since I already blew it for the day I might as well go for it! Where's the cake?

Do any of these sound familiar? It really is true that the hardest part of weight loss surgery is not the surgery, it is the head stuff that goes along with it. For the first time in your life you are forced by sheer nature of the beast to confront your food demons. When you reach for that scrumptious food item and cannot eat enough to fix whatever is wrong, your issues are staring you in the face. I think it is normal to have a little denial at first and you ignore the food monster staring at you and you keep searching the kitchen looking for something that will fit in your stomach but... nothing is there. Frustration sets in and you swear you are hungry even though one more bite of food and you will be hugging your porcelain friend.

It is this crazy insane cycle that has to happen a few times before we begin to really "get" it. You notice a pattern that cannot be denied anymore. You feel stress, you eat. You feel sadness, you eat. You feel anger, you eat. You feel boredom, you eat. Patterns, but no real answers. Right?

There are a number of self help books out there, some great and some not so great. Everyone has their own take on the fix for our issues. I found a book I like and I will tell you why. It doesn't tell you of the horrors of eating food animals, it does not use aversion therapy, it does not give you one fad diet after another promising a forever cure to the disease of obesity. This one is not a diet, not a promise of a quick fix but instead more of a cognitive therapy approach. It is a set of daily exercises (mental and written, not physical) for six weeks. She writes what I call positive affirmations but she calls it a change in the way you are thinking. She's the PhD so she is probably correct! The book is:

"The Beck Diet Solution Weight Loss Workbook"

She has two books, one is a workbook and one is not. I suggest the non-workbook for pre ops and the workbook version for post ops. You honestly do not need both. Oh, you can buy both of them but I think you will find you are wasting your money.

In this book she has you change negative thinking to positive thinking but more important (at least to me) is you end up learning why you do what you do. You have written exercises, you have daily schedules to complete, food logs, columns to compare, and thinking to do. Not only do you face your demons you learn new coping methods. You learn to face your own behaviors and find alternative ways to cope. Really, a big part of this whole thing is being honest with yourself when you are eating for emotion instead of eating for nourishment. When you are eating because you found a way to justify it instead of when you are eating because your body needs fuel.

A big shocker for many is to understand a few key points here.

We can feel hungry, we can feel satisfied, and we can feel full. We are always looking for that full feeling. Thanksgiving Day full, feels so miserably good. Right? Did you know naturally thin people do not want to have that full feeling? They are very content with satisfied, or not hungry. It is us, our population that wants to be in misery we are so full. And in an hour we will do it again! How crazy are we? Well, we aren't crazy. We have a disease and that disease is called obesity.

A really good place to order this book is:

www.ADDall.com >> used and out of print books >> insert author name "Beck" >> insert title

This site is great because it combines ebay, Amazon, and 20,000 private sellers and this book is listed all the time by many sellers so you get to pick your price. As of this morning the book version was $1.41 USD and the workbook version was $6.00 USD. They have US sellers, Canadian sellers, and European sellers. Pick your country and pick your price. Although the books are listed as used most of them are actually new.

Another book people seem to like however I have not read it is:

"Good Calories, Bad Calories" by Gary Taubes.

Go to Amazon.com and read a few pages of each book and see what hits home for you.

Now, there is another reason some people eat the way we do and this is my own personal demon. OCD. Obsessive Compulsive Disorder. It is really the only area OCD seems to affect me, food. When I am stressed or frustrated I absolutely obsess over food. I think about it non stop and while I am eating I think about what I can eat when there is room in my banana sized stomach. I do not experience this all the time, just stages. I can go for weeks and it does not seem to kick in and all the sudden it is there full force. I look up recipes, I look at menus for various restaurants on line, I go to Recipekey.com where I can put ingredients I already have in my kitchen and it will give me recipes where I do not have to go to the store.

This is when I start taking Effexor. I am supposed to take it all the time and I do not. I take it for a couple of weeks here and there. This is what works for me. It kills my head hunger. My stomach rarely feels hungry due to the surgery type I have but my head goes through stages where it insists my stomach wants food.

I am very sure that I am not the only one out there that obsesses over food. I have talked to so many people that have the same issues and if it is indeed OCD, the medications can work quite well. If you feel this is your issue as well I suggest you talk to your doctor. Some are willing to let you try pharmaceuticals and some are not. Just find what is right for you and go for it!

Getting Real - Gross Stuff That Happens After WLS

2010-03-17T16:03:00.000-07:00

Pre ops daydream wondering what it will be like to have a thin sexy body. They fantasize about cute clothes, the opposite sex (or same) doing a double take. They cannot possibly wait for the day they can dress up, look good, walk proudly, and everyone will gasp at the changes. The idea of going shopping and buying tiny little clothes that fit makes women dream before they even go to sleep at night! You know, these are all good and reasonable expectations - to a point. But you have to know there is a bit of a price to pay to get there. The upside to this is that with a little effort they are all doable and you can fix them! If you know about it beforehand you are ready to prevent problems and issues.

Burping-

This is common in all surgery types for up to a couple of months post op. It is merely esophageal irritation and it will go away in no time! It can also be from swallowing too much air. It takes time and practice to learn to stop the behavior. It was never a big deal before when you had a normal size stomach. Today you are using a small portion of your original stomach and a small amount of air goes a long way.

Constipation-

I think most experience it post op regardless of surgery type. Sometimes on the liquid stage of the post op diet there is diarrhea (liquids in/liquids out). But after that it is constipation. It happens for a variety of reasons. High protein/low fiber diet, not enough liquids, drastic change in diet, pain meds, lots of reasons. Also, keep in mind that before this whole journey started you were eating a lot more food than you are now. You aren't supposed to pooh as much today as you did a few months ago.

It is my experience from reading the boards that while all surgery types can experience this banded folks and bypass folks seem to experience this the most. As a previously banded person I can tell you that it was a serious challenge to eat fibrous foods such as broccoli. Bands and bypass have a stoma and many times it is hard to eat veggies with a stoma until a 6-12 months post op. Not always, but sometimes. Also, with an itty bitty stomach it is more of a challenge to get needed fluids in and we tend to get lazy and simply not drink as we should.

The very best cure for constipation is prevention. Seriously, do what you need to so you do not end up with a problem that leads you to an Emergency Room with an old guy wearing thick glasses lubing up a gloved hand and going on a digging expedition. You will not enjoy it and neither will he.

Most tend to reach for a laxative and that is not always a great option. That is something you might have to resort to but it is not something you want to do on a regular basis, just in a pinch.

There is Metamucil and I do NOT suggest newbie post ops, bands, or bypass use this product. It can set like a firm gel and be very painful in your stomach.

Benefiber is good stuff, easy to take, and no taste. You can actually mix this product with water and after it dissolves you cannot taste it. The down side to this product is that it can take a good month to work if taken on a regular basis.

Miralax is a great product and no longer by prescription only. You can buy it at any decent size drug store. It is a powder that you mix with a sugar free drink. You can take it as a preventative measure or to fix an already existing problem.

Colace (The generic is fine, Docusate Sodium) and this is a stool softener. It will not fix an existing problem but it will prevent you from getting constipated to begin with.

Then the usuals, prune juice, baby food stewed prunes, apple juice for some, and other assorted fruit juices that seem to get people going. Plum juice is reported by many to do well.

Monkey Breath-

While constipation bothers you a great deal more than those around you, bad breath bothers those around you more than it does you.

Usually this is from ketosis. When you start cutting carbs and burning fat the burned fat changes to various chemicals and those chemicals are released through body fluids such as urine, saliva, tears, and one other - when you exhale. So your breath is going to be bad. You can brush your teeth until you brush the enamel off your teeth, your breath is still not going to smell minty fresh. It will smell like minty monkey breath. The solution is sugar free mints, sugar free drops that are breath fresheners, and just anything you can grab in a hurry if you are in an enclosed space with someone such as a small office, car, etc.

Body Odor-

This does not happen to everyone but it does happen to many. Remember, there are lots of toxins and such stored in fat cells and as you burn the fat sometimes you smell bad. It has nothing to do with obesity, it would happen if a thinner person burned fat as well. The solution is simple, shower daily.

Also, sometimes as people lose weight they end up with more skin folds. Lots of nice warm dark places for fungus to grow. An antibacterial soap is not going to help but it might hurt. An antibacterial cannot kill a fungus. You need an anti-fungal. Jock itch spray, athletes foot spray - these products can fix an existing problem.

Nausea-

You just had major surgery. Your stomach is not happy, some people get nausea and it is usually is temporary. Your doctor can prescribe anti-emetics (stops nausea) or you can try some home remedies. Coke syrup can be purchased at Walgreens or any large drug store. (Bypass patients could dump on this.) Another good one is licorice tablets found at health food stores. Usually one dose before each meal does the trick.

Smelly Gas-

This is more of a problem for people with malabsorption such as Gastric Bypass and DS. Due to the rearrangement of intestines the body is unable to do the job as intended at birth. Sometimes there is an overgrowth of bacteria in the GI system and this can create gas, smelly gas. Usually probiotics prevent the problem and Flagyl (a prescription antibiotic) fixes an existing problem.

This problem seems to be worse after eating refined processed white carbs.

Female cycles-

Many women complain of changes in their cycles. Female hormones are stored in fat cells and as we burn fat hormones are released. This can play havoc on your cycles. Some women have harder more painful cycles until their weight evens out a bit and some have fewer cycles.

Sadly there are not a lot of fixes for this. If you take additional hormones you are risking blood clots and strokes due to obesity. This is something that if problematic, talk to your GYN.

For those with PCOS you might find that after surgery you start having cycles again or if you have cycles just not often you might become more regular after losing even 30#.

Do note: After losing massive amounts of weight you are very likely to be far more fertile and this includes PCOS women as well as non-PCOS women. If you want a child then please wait for a year or so after getting to goal before getting pregnant. Your body needs to heal from massive weight loss before you can safely carry a baby. This is for your safety as well as the baby.

Excess skin-

This is a much discussed topic on any weight loss surgery board and there are so many myths and misinformation posted.

It is NOT true that slow weight loss means less excess skin.

It is NOT true that exercise will prevent excess skin, while it may fill out a small bit of skin with firm muscle, it will not affect excess skin.

It is NOT true that moisturizers prevent excess skin. While it may improve the overall appearance of your skin, it does not prevent excess skin.

It is NOT true that you can have plastic surgery done for a discounted price in trade for donating excess skin. Burn units cannot use our skin, it has no elasticity anymore, it is not healthy skin and burn patients cannot use it.

Skin is skin just like any other organ in your body and once it is damaged it does not usually go back to pre-obesity days. It depends on several factors such as genetics, amount of excess weight and similar issues.

You will not know for sure one way or another if you will have this problem. If you do you can buy binders and special clothing to smooth things out a bit or you can have plastic surgery. Never forget, as you will see on various boards time and time again, you can hide excess skin. You cannot hide excess fat. Just worry about getting healthy, deal with skin issues when you get to goal.

As you can see none of these issues are things we cannot overcome. Just know about them beforehand so you can deal with them if they happen. I swear to you, all the above is nothing in the whole scheme of things once you hit goal.

Eating Clean - Slowly Changing Food Habits

2010-03-15T18:52:00.000-07:00

Have you ever heard the term, "Eating Clean?" It is basically all about getting down to basics. Instead of buying canned beans, make your own! It is *so* easy, cheaper, healthier, and you control the fat, sodium, and best of all - lard! Instead of eating processed foods such as fast food, Hamburger Helper, Tuna Helper, canned soups, canned foods in general it is all about getting down to basics.

This is a great thing to start before you ever have surgery. The trick to eating clean is not to decide tomorrow you are going to do it, that is all wrong! That is where we fail. The key is gradually introducing good foods to your diet. Do not take away everything all at once, you will be left feeling deprived, depressed, and you will be unlikely to do well. Instead of taking away, ADD foods!

What is your diet like? Fast foods and processed foods? That is probably what you eat if you are like a majority of people today. Do you want McDonald's? Fine, eat it... for now. ;o) But add something healthy to it in the meantime. Daily add a new food. Alternate between fruits and vegetables. What veggies do you like? Do you like broccoli? Fine! Today add 1/4 cup of broccoli to your diet. Eat what you will, but eat the broccoli first. Tomorrow, add a fruit. Do you like bananas? Great, tomorrow add 1/4 cup of broccoli and a small banana and eat as you usually do. But eat the fruits and veggies first, the the McDonald's.

What about the day after tomorrow? Add another veggie. Do you like carrots? Great! Add 1/4 cup of fresh carrots. So before your main meal you'll add 1/4 cup broccoli, 1 small banana, and 1/4 cup of fresh carrots. The day after add another fruit. Daily just add a new fruit or veggie. Do not, I repeat do NOT take away foods at this point. Do not deny yourself McDonald's, but do eat the fruits and veggies first before your main meal.

As the quantity of food increases daily start spreading the fruits and veggies out throughout the day before meals. Soon you simply will not be able to eat in quantity anymore, you will be unable to eat all the fresh fruits and veggies as well as the processed and fast foods.

When we diet we are taking foods away. That does not work, right? So add foods. Supposedly some brilliant person somewhere claimed that it takes three weeks to learn new habits. I do not know, maybe that is true, maybe not. But I can tell you that new habits do happen with time. Before you know it you really end up craving that fresh salad made your way vs. the processed foods you had been eating. This does not happen overnight and that is okay. Our bad habits did not happen over night either.

Go to the grocery store. Do not bring your spouse or your kids, they will annoy you. Go by yourself when you have a good hour to roam the produce section. Look at the colors of the produce. Yellow squash, green broccoli, red bell peppers, purple cabbage, orange oranges, yellow bananas, shop by color. Seriously stop and look at all the produce, find something you have never tried before and buy one. Take it home and experiment with it, look up various recipes, find something that sounds good. Better yet while you are in the grocery store find someone with a huge cart full of all produce and be bold, walk up to them with a produce item you have no clue how to prepare and ask them. Do what I do, find any sweet little old lady and ask her how she prepares whatever item you are holding. I have yet to have a little old lady that did not give me a cooking lesson if I asked for a bit of education. And let's face it, little old ladies are usually GREAT cooks!

Try one new produce item every week. Some will be winners and some will be gross. That's okay! You tried it but the point is, you will find items you do like in the meantime.

SALADS-

Make great salads! The key to a great salad is that you put items in there that you like. Make it your salad! And do not forget, not all salads have to contain lettuce. My favorite salad (I will post the recipe with dressing in full later in the blog under recipes) has no lettuce. It has:

Black beans
Corn
Celery
Onions
Serrano
Red bell pepper
Green bell pepper
Pineapple

Add items you like and take away what you do not like. Want more heat? Add jalapeno peppers instead. Maybe your surgery type does not work well with stringy pineapple so add diced apple instead. The key to a good salad is only put ingredients in there that you like and add lots of tastes and textures. Soft beans, crunchy bell peppers, sweet pineapple, flavorful onions. It is a burst of flavors and textures with each bite. It keeps your mouth and mind interested.

Do you like lettuce salads but your WLS stomach disagrees with your mind? Try salad with no lettuce. All the veggies you would usually put on a salad put in a bowl. Something like:

Tomatoes chopped
Celery diced
Onions diced
Radishes diced
Yellow squash diced
Zucchini diced
English Cucumber diced

Whatever veggies you would usually put on top of salads just cut them up, put them in a bowl, marinate in Italian dressing for a few hours and enjoy.

Try new salad dressings and do not be conventional. Be creative and try new foods! You might just like them!! A staple around my house is the following:

PICO DE GALLO

Roma tomatoes, quartered, remove seeds, chop fine 2 medium
Tomatillo 1 medium chopped fine
1/2 Red or Yellow onion, diced
1 Serrano (for more heat use jalapeno pepper instead)
Cilantro to taste
Salt to taste
Lime juice 1 tbsp

With the lime juice it will keep well for 4 days. Use that as a salad dressing, put on top of chili, make tostadas, refried beans, cheese, Pico de Gallo.

Try new flavors of salad dressings. Sweet, sour, tart, whatever your pleasure. My favorite store dressing is made by Girards, it is in the salad dressing aisle, in a glass triangular bottle and it is Chinese Chicken Salad.

Diced chicken
Romaine lettuce
Those tiny baby corn on the cobs (sorry, I do not know the proper name)
Water chestnuts
Crunchy Chinese noodles
Girards Dressing

Try Extra Virgin Olive Oil based dressings, the oil is good for you, for those with bands or bypass and you have a stoma it does help to lube the food through your stoma, it is the right kind of fat, and it tastes good. Dressings do not end with Mayo alone.

The key to a good salad again, making it your way, lots of colors, lots of textures, and lots of flavors. Think of salads as you would your family recipe for chili or spaghetti sauce. There are as many recipes as there are people cooking. Make it your way, that is all that matters.

BEANS-

Instead of buying canned beans make your own. It is so much better and after you make your own beans - canned just will not do the trick anymore.

A general rule of thumb:

Soak dry beans in water for 8 hours or overnight,
Never salt beans until after they are cooked or they will be tough,
Use your crock pot/slow cooker because it is easier,
Use Crock Pot/Slow Cooker liners so you do not have a huge mess to clean later.

That is it. Soak your pinto beans, black beans, lentils, whatever your pleasure throughout the night, using a crock pot liner use the entire bag of beans with more water, chicken stock, vegetable stock, whatever you have around. Add chili powder, onions, and garlic. Let the beans cook all day. Use what you want for a recipe and put the rest in the freezer for next time. They freeze well and you always have fresh beans for a recipe.

Make your own refried beans, it is far easier than you may realize. Just cook your favorite beans as outlined above, reserve a small amount of the water they were cooked in, add a bit of EVOO, more chili powder, garlic, salt, pepper, and smash. That's it, you do not need to fry them unless you want to. My favorite is refried black beans. The texture is much more smooth than pinto beans.

Add beans to lettuce salads, soups, chili, make bean salads, the list is endless.

Quiche (From Ana O'Donnell:

In muffin cups, mix:

2 cloves minced garlic
2 cups chopped broccoli
1 tbsp olive oil
1/3 cup 2% milk
7 eggs
1 cup shredded mozz (used whole milk b/c that's all I had on hand)
A bit of Mozz cheese

Mix, stir, whatever. Pour into muffin cups line with either liners or EVOO and bake at 350(F) for 12 minutes. She said they are 90 calories each and you have good protein, good fiber, and good food!

When you go grocery shopping, shop outside the aisles. Produce, meat, dairy... those are the sections you should buy most of your items. The aisles are where you'll find the overly processed foods. Canned meats, canned veggies, canned fruits, canned dinners, canned pasta, all the foods that got us fat to begin with are there. Shop the perimeters of the grocery store, that is where the best foods are.

Again, please do not try to make fast and drastic changes to your diet, it does not work. Do not take away from your diet just yet, add to it instead. Try new foods every week when you go to the store. Shop the produce aisle by color and buy lots of colors and try one new item weekly. Make your food fun and interesting by adding lots of textures, colors, and flavors. Make food the way you like it.

WATER-

Water is essential for health and clean eating. It is probably more important during the weight loss stage and there is a reason for this. When you burn fat that fat is turned into chemicals that your body gets rid of via bodily fluids and when you exhale. Mostly it is in urine but it is in saliva as well. It is critical to flush out these chemicals as you burn fat.

Nothing really replaces water. Juice does not replace water, it does make your pancreas work to pump out insulin due to the blood sugar spikes. Same with milk. Tea typically has caffeine and that makes your heart work harder. Sugar free drinks still have chemicals and sweeteners. Nothing beats plain old water. If you can get it down plain, that is best. If you just are not a water drinker then please, at least get sugar free, caffeine free liquids down daily.

PROTEIN-

Protein has multiple functions:

1. build and repair body tissue.
2. maintain cell growth in the formation of new body tissue. This is especially important if the body is growing rapidly, injured, or under stress.
3. aid in the formation of enzymes, some hormones and antibodies.
4. provide as energy if sufficient carbohydrates and fats are not supplied by the diet.

A protein is basically a full chain of 23 amino acids. If not all amino acids are present then it is not a full protein chain. Foods that are complete protein chains are foods such as beef, chicken, duck, goose, pork, fish, seafood, elk, and bison as well as most dairy, brewers yeast, most nuts, etc. Foods that are a partial protein chain are most beans such as black beans, pinto beans, (It should be noted that lentils are a full protein chain.) grains, and peas. Protein must be consumed daily. While you can go for several days without protein especially immediately post op, you should do your best to consume protein as soon as possible.

Protein will also help boost metabolism if in a lean version such as lean meats.

"Proteins are needed at all meals but especially at breakfast to replenish amino acids used for growth and maintenance during the night. Excess protein not immediately needed by the body is converted to fat and stored in adipose tissues to be used as energy. Unfortunately it cannot be converted back to amino acids." (source is: http://www.uen.org/Lessonplan/preview.cgi?LPid=1269, I cite this source since it is a controversial topic of when and how to consume protein.)

A healthy diet is essential to weight loss. Massive weight loss is a huge insult to the human body, we can overcome potential future problems by a quality diet of unprocessed foods. Getting to basics is essential to health and simply feeling good.

Enjoy your food!

Body Scan of Person 250# vs. 120#

2010-03-14T19:28:00.000-07:00

Check it out, this is a comparison of a body scan of an obese person compared to a 120# person:

(***NOTE*** Please double click on the photo for a full view.)

Liver-

Notice the liver size, fairly remarkable, right? The lower lobe of your liver sits in front of the stomach. This is what your surgeon must keep out of the way during surgery. If you do not follow the pre op diet your liver will be very slippery and hard to manage. If surgery is difficult for your surgeon, it will be more dangerous for you.

Follow the pre op diet! ;o)

Heart-

Obesity does not only affect the heart of a person, but his liver and other organs as well. But more often than not it is the heart that gets the biggest hit. People who are obese are very likely to develop high blood pressure and can even lead to paying more for health insurance or being denied health insurance completely. If a person is suffering from this condition there is risk of developing other heart problems such as stenosis, regurgitation, endocarditis, arteriosclerosis, and other similar diseases. And the moment any one of these develops heart attacks are likely to happen. More serious conditions may even arise such as the sudden or gradual loss of life. In other words, you can die.

Kidneys-

Notice how the organs appear smashed together in the obese person? Think about your kidneys, when that much fat tissue is sitting on your kidneys this in turn causes your blood pressure to increase. There is an increased risk of kidney damage for this very reason if you are diabetic.

Lungs-

Studies have shown that obesity affects the lungs and its air passages as much as the heart. In children, obesity could prevent proper lung growth. When that happens the child's pulmonary functions are reduced in a level where diseases such as asthma and other respiratory problems result. Several researchers have further proven that obese people are more prone in developing asthma. But when these people reduce weight the possibility of having the disease is lessened.

Muscles-

Check out the heavy person's thigh muscles and compare them to the thin persons thighs. The heavy person has far more muscle mass. They need it to carry around excess weight. During weight loss remember, you WILL lose muscle mass, it is not a question of if you will lose it, it is a question of how much you will lose. The more muscle mass you have the faster you will lose so you want to maintain as much as possible. This is done through protein and weight resistance.

Pushing and squishing your organs is not healthy for your body. It causes each system to work harder than it was designed to. Organs can be like auto parts, they wear out after time. When we all overwork our body systems this is what happens.

My Advice To Newbie Post Ops

2010-03-13T17:12:00.000-08:00

My first thought is for newbies that just had surgery. If you haven't reached the point of regretting the fact that you had surgery, just know you will. If you are a normal, typical, average WLS patient you will very likely go through a phase where you regret having the surgery. You ask yourself what the heck you just did to your body!

Just know, this is common. It WILL pass! Give yourself time, most of us feel that way and it usually happens right after surgery and might last for several weeks. But it will pass. Give it time.

There are a lot of head games that go with weight loss surgery. We are accustomed to large quantities of food, and the type of food that does not work well for weight loss. I was the fast food queen, ate it twice daily every single day. Burgers, onion rings, tons of diet soda, the works. I ate so much fast food that my band will paid for itself in fast food savings and soda savings in 1.5 years. Isn't that horrible? I'm talking $7800 for the cost of my band!

You know those reformed smokers? They smoked like a chimney for years and when they quit the rest of the world must quit? They suddenly claim to be "allergic" to smoke? They are rude, insulting, obnoxious, and believe they are doing a good thing? That's the way I am about fast food. I am a reformed fast food junkie. I don't think many had a diet as horrible as mine before banding. One can be obese and malnourished at the same time and that is probably a good way to explain my own pre-band eating habits. It was that bad. Pre-sleeve I was a fully reformed fast food junkie. ;o)

I explain this so you know I fully understand food issues. BTDT a million times over.

Some people seem to struggle with white carbs such as bread and pasta (me) and others seem to struggle with sugar and sweets. Those are the big ones. Some struggle with alcohol but I'm not sure that is primarily a WLS issue but more an alcohol issue that gets in the way of weight loss. Some claim to eat mostly veggies and they just don't know why they are obese. Is there a better example of denial than that? ;o)

Having WLS does take much of the joy out of eating. I don't think it matters which procedure you have, much of the joy is taken out of food. The non stop chewing, small quantities, food limitations, the works. In many ways I think that is a good thing. It's the joy of eating that got us fat. We can't imagine a time when we would ever prefer not to eat because it is unfathomable to comprehend that food might not be as fun someday. We can't comprehend that it might not fill a need somewhere. The need to inhale food - large quantities of food. We like the taste, the texture, the full feeling... we like it all. We eat until we experience extreme discomfort from eating so much yet we want to continue doing it. Doesn't make a lot of sense, does it? Another obese person would understand this but a thin person would think we are crazy. I don't know, maybe we are crazy but you know what? It is what it is.

When you have any weight loss surgery (bypass, band, sleeve, whatever) it takes much of the joy out, what we are used to. We are used to inhaling anything we want. We are used to that Chocolate cake calling our name and we have to wait until we can stuff another bite down before we can inhale that, too. We are like a food vacuum cleaner, we suck it ALL up.

After surgery you realize you can't do that anymore and it's frustrating. You see and you want to eat it but you know there isn't a chance in the world it is going to go down. Think about it, when you were pre-surgery and dieting when you grew sick of the diet you could cheat. WLS doesn't permit you to cheat in the same way and with the same quantity of foods and it gets old in a hurry. This is the time to continue reminding yourself that this is a lifestyle change. This is it, we are here, living it, choices have been taken from us. We intentionally took our own choices away from ourselves because we couldn't achieve goals without it. Food choices, our choice in eating habits, it's gone. Never to return. That's one if the biggest head issues we have to deal with. There is no turning back.

I think it's kinda typical to start eating around the surgery during these times so you feel as though you have control over the procedure vs. the feeling that the surgical procedure has control over you. You have to get to a point that you accept it isn't a control issue but a tool that you need to lose weight. You can fight it, but it isn't going to work. But you know what? We try anyway. Then comes more frustration. I think this is the point that we need to give ourselves a reality check. We all have to accept that this is it, do it or don't. Most accept it and move on with weight loss and a small minority do not. My best friend is a prime example. She eats her 800 calories a day in good food and a whopping 3000 calories a day in Chocolate.

If you are not losing weight I suspect you are going through a phase where you are sick of dealing with weight loss, you are sick of chewing chicken to a liquid, you are sick of it all and I think those phases are normal. Let's face it, it's a great deal more fun to maintain weight vs. losing weight. That's why I wanted it over with in a hurry and kept calories at 600 daily and busted my butt doing hard cardio daily. And no, Dr. Aceves did not approve of my caloric methods but I wanted the fat chapter closed once and for all. I was sick of a battle all the time of losing weight. I felt like I was fighting the world and in reality, I wasn't. I was fighting the lifestyle change. When I accepted that this is my new world, my new reality... I was able to move on and get it done.

Have you noticed that your world revolved around food a lot more pre-surgery than it does now? Now you have days where you put off consuming food because it is a chore. Did you ever put off consuming food pre-surgery? I don't think this is a bad thing. Pre-surgery we can't comprehend the thought that food will not rule our lives. Our world revolves around food. We eat breakfast and while we are eating it we wonder what we'll have for lunch. When we eat lunch we think about what is in the freezer for dinner. When someone mentions the name of a restaurant we immediately have a vision of the menu and know full well what we will order and it will be the largest portion sizes on the menu in all likelihood.

Have you ever been asked to go to dinner with someone and you didn't want to eat your usual portions in front of others so you eat before you leave the house so you can pretend to eat small portions while dining in front of others? Ever go to a fast food restaurant and pretend you are ordering for more than one person? In reality, it's all for you. Food ruled our lives pre-surgery. Post-surgery we wonder what we should be doing with all the extra time where we are no longer consumed with food issues.

Not sure if any of that resonates with you, but I think bits and pieces might.

Wine... I think you'll find many experienced WLS folks say that if they drink alcohol it will stall weight loss a great deal. It shouldn't, the calories are incorporated in your daily count but it still stalls weight loss. At least it does for me. I don't drink much now that I'm at goal. It hits me too hard, too fast, and even with just one glass of wine I'm not at my best the next day. But that's me, not everyone is the same. But again, I think you'll find many experienced WLS folks saying alcohol stalls weight loss every single time. And let's be frank here, if you are in the weight loss mode you do not need or require a couple of glasses of wine a few times a week. We are only permitted limited calories daily. If you drink a couple of glasses of wine you either are going over in calories or you are not getting good foods in. Either way it simply isn't good.

Are you eating soft foods? Liquid calories? Cottage cheese and creamed soups? Congrats to you for getting protein in, but it's the wrong kind of protein for your surgery type. I know it is easier to get cream of chicken soup down vs. solid chicken, but you know what? This is the game we signed up for. This is the lifestyle we paid a lot of money to obtain. So change from soft foods and liquid calories and get back on track. A half cup of roasted chicken is going to have fewer calories than the two cups of cream of chicken soup you are consuming now.

Are you cooking your own chicken? Are you cooking it so long it is dry and hard to eat? Or is chicken just not doable with your surgery type? Try going to the grocery store and buy a roasted chicken. Eat a small piece and see if it goes down better than what you make. If it does it might be that you are overcooking your chicken and it's simply too dry. Canned chicken soup has some of the most overcooked meat around and even cream of chicken has pieces of solids in it. If you can get that down, you should be able to get roasted chicken down.

If you are eating the right foods and have appropriate restriction you really shouldn't need snacks. That quickly become habit and if you snack too much you mess with your 800 calories (or whatever your doc suggests) daily that you are allowed. Then you don't get the appropriate quantity of food necessary for meals and you will be hungry sooner.

Ice cream... hello? Need I go further with that one?

How are your teeth? Are they in good condition? It's a serious question and quite important. One thing I don't think many realize is that if your teeth are not in super great condition you may not be able to chew the bandster/sleeve/bypass way. If your teeth need work, get it done.

Are you tracking calories? Many times it's easy to put off tracking calories if you are eating ice cream and drinking wine. Seriously, we don't always want to know the number of calories we are consuming. Then we'd have to be honest with ourselves and that can easily be a hard pill to swallow. If someone is losing well and feeling good there is little reason to track protein and calories. But if weight loss stalls it's time to take a long hard look at what is going in our mouths. A few ways to do that are to run anything you are not absolutely positive of through:

www.nutritiondata.com

It will give you a very complete food label for any food item or total recipe.

Then track that information on:

www.thedailyplate.com

or...

www.fitday.com

or...

www.sparkpeople.com

See what is actually going in your mouth on a daily basis. Be honest, nobody will see it but you.

So cut out the wine, ice cream, and candy bars. Make this new lifestyle a habit you prefer and amazingly, that really does happen over time. Your tastes change and you prefer the good stuff. You look at ice cream and think that sounds so good. Today over three years post op I think the SAME thing about a salad. Crazy... I know. But it does happen. Bump up your exercise. We have biological and emotional reasons for overeating, we have no excuse for not exercising. None.

Change the liquid calories and soft foods to solid proteins. When the scale starts moving like crazy you will find all kinds MORE motivation. Buy new clothes that actually fit vs. hanging off your body. That is very motivating as well. You can do this, but you have to do your part. No more excuses. Accept this is your lifestyle and use it to your advantage.

Good luck!

Get Motivated; YOU CAN DO THIS!!

2010-03-12T17:43:00.000-08:00

I'm going to get hammered for writing this but that has never stopped me before. You know these people that eat pizza and tacos a few days after surgery and they come to the boards asking if they just messed up? You know those people that pat them on the head, tell them it's okay, and to "try" to do better tomorrow? Yeah, I'm not one of those people. I tell them to knock it off, they are risking their health and why? For a lousy taco?? Are they serious? I don't suggest they TRY to do better the next day, I tell them to DO better right now.

I think we often times do not give ourselves enough credit. We think we are weak willed and powerless over the world. That simply is not true. We have been living a life of fat for many years. You tell me the weak willed and powerless can do that, I won't believe you. Being fat in today's society is no easy task. It is really damned hard. Yet we survive it and if we can survive that, we can survive passing up a doughnut. Let's face it, it is much easier to pass up a doughnut than it is to have to buy two airlines seats because our butts are too big for one seat. It is much easier to pass up a single doughnut than it is to face ourselves in the mirror of Lane Giant after realizing we are yet... a bigger size than the last time we were there. We face humiliation and embarrassment every single day just due to our size. I think sometimes we tend to get used to it and forget that humiliation and embarrassment are NOT normal and a part of life. We also pretend it does not hurt as much as it does.

I'm not trying to be a skank about this but you know, WLS is our last shot at weight loss. This is a big deal, we have choices and too many times we are all making the wrong ones. I don't eat a lot of junk because I don't need it. Neither do you. I disagree with those that say ANYTHING in moderation is okay. The reason I disagree is because ALL of us did not get fat because we can do moderation well. With any WLS our caloric intake is cut drastically and we need every calorie for food we actually need and use. The only thing cake, pasta, or crap food will do for your body is make it more plump.

This is a lifestyle change and a lifestyle change does not mean eating the same load of crap but just less of it, that means overhauling your diet and eating food that your body needs and does something positive for it. What "value" does Chocolate cake have for your body?

So does this mean that you can never have a piece of birthday cake again? Of course not. It means that eating junk on a regular basis serves no value. We don't know what moderation is so we have to go searching for it. Moderation does not mean limiting ourselves to crap food just one time daily or one time weekly, it means more along the lines of on birthdays, special occasions. When we "plan" on eating junk weekly, what does that make our thinking? That means we are *still* planning our lives around food and poor choices. Thin people do not set out to plan on when they will eat a load of crap, they don't even think about it until the birthday party or social meeting is there staring them in the face. Yet we fatties actually plan a date and time to eat bad food. See the difference in thinking between a fat person and a normal size person?

The lifestyle change is not planning on WHEN we will have loads of crap food, lifestyle change means actually going out there and living what we claim we want. Life as a normal size person.

If you can face the humiliation of being obese in society, can you honestly sit there and tell yourself that passing up junk food is harder than being the fat girl walking into a room where being morbidly obese is socially unacceptable? I mean, I think there comes a time when we have to put things in their proper perspective and this is one of those times. Next time you want junk food get real and get honest with yourself. Get a photo of that food item and a photo of a person that is the size you want to be. Which do you want more, do you want the cake more than you want to be thin and healthy? Be very honest with yourself. If you prefer the cake over thin then just go for it and have the darn surgery reversed. But I will bet you would rather have thin over a piece of cake when you really get honest with yourself. It's all about perspective and self awareness of what you want out of this life. We have a choice, and it IS a choice. We can be fat or we can be thin. With WLS thin IS within grasp.

The thing about us fat folks is that traditional diet and exercise is too hard, we just cannot do it. We cannot lose and maintain at a normal size weight. Call it a lack of self control, call it anything you want. I will gladly cop to it, I will be one to stand right up there and admit that I cannot do it. But with WLS it is still hard but it is the kind of hard WE can do, OUR population. Losing weight with WLS is the kind of hard we can do but without it, nope... we cannot do it.

Sometimes, maybe often times, maybe 20x a day when we are justifying more grazing behaviors and opening the frig to see what unnecessary food is in there, there comes a time when you just have to tell yourself no. We tell our children "no" daily. No, you cannot play with razor blades in the middle of a busy street. No, you cannot eat rat poison. No, you cannot fail to look both ways when crossing a street. No, you cannot do drugs. Sometimes we have to tell ourselves no as well.

If you are like me, not sure you are, but if you are like me I cannot stop at one Frito, or one bite of this or that. For me it is all or none. If I eat white carbs I cannot quit. I lose self control. If I stay away from them completely I have no problem. The more I eat the more I crave. I am a person that wanted bread so bad about 3 months after banding I actually broke into the bread crumbs I use for cooking and ate the whole can. Then I started in on dry stuffing mix. It was not even something that tasted good (Pretty nasty, to be honest.) but I could not stand the carb cravings anymore. That was my moment when I realized when and how I lose self control. So I avoid those situations.

You can come over to my house right now and look through my kitchen. You will not find any flour, pasta, bread, Fritos, or other foods that are my triggers. There are no bread crumbs, stuffing mix, cake mixes, cookie mixes... none of it. I do not even keep it in the house. There is not a person that has ever once been in my home that even needs those foods. My husband does not need them and he does not get them if he is here. Why would your family NEED cakes, cookies, etc? We are not punishing our family members by denying them food habits WE have, it really is okay if you do not load your cupboards full of crap your kids do not need. I think that is another mindset we have to change. I have seen people post on various message boards that they cannot pass up the cookies in the cupboard but they cannot punish their children by not having cookies in the house. Since when it is a punishment to decline to feed a growing child cookies to the point you can't have a day without them in your home?

Exercise-

see more dog and puppy pictures

You know, we have physical and emotional reasons for overeating. Those issues we have to overcome and find ways to deal with them. But exercise? Nahhh, we have no excuse. That is just plain lazy behavior. You do not like exercise? Neither do I. But it's like cleaning the toilet. Who DOES like to do it? We do it because we have to. It's just a responsibility. We are all great at justifying eating too much and not exercising but the reality comes down to sheer lazy behaviors. If you can't run then power walk. If you can't power walk then walk. If you can't walk then do chair exercises. We have the energy to get up and run to the frig 20 times a day yet we can't find the time nor the motivation to do the SAME walking outside and away from food. How does that work?

There are people who LOVE exercise, bless their little hearts! It's like a transfer addiction. They go from eating to exercising. They love it. Personally, I think they are sick and twisted human beings. I exercise but I hate it. Never have enjoyed it, not even a little. The person who invented weight resistance cannot possibly be anything but a lover of S&M. They should be shot but you know what? It really really works. The motivation for me was not busting my butt on a treadmill when I would have much preferred doing my nails. The motivation was that the more I exercised the more weight I lost. THAT was my addiction, losing weight and getting thin. The more you lose the more motivation you get.

What if you do this, just for ONE week; one week only. Cut out ALL white carbs. Yep, you'll be climbing the walls, you'll be dealing with head hunger full force. Every single TV commercial for food will be calling your name. You'll cus and swear at me and everyone else that is around you in real time or the boards. Start exercising. Even ten minutes of brisk walking. Work up a sweat, bust your butt. Just 10 minutes. That's nothing, that is the same as a couple of TV commercials. That is about the same amount of time to read a single post on my blog. (But please, do not quit reading my blog! ) Just take 10 simple minutes and go out for a hard walk. Then you are done exercising for the day. Honestly, 10 minutes is NOTHING. We have 144 10 minute blocks in a day, it really is nothing.

Then tomorrow do 11 minutes. And yes, time it from the time your walk is a brisk one, not when you start thinking it is time to go outside for your walk. When your pace is up to brisk then start timing. Daily add a single minute to it. Push yourself to do better each day, just a single minute added.

So for a week eat what you want, do not worry about counting calories, do not count fat grams. Do not worry about calories in the least. Eat what you want but do limit WHITE carbs to 20 a day. I'm just talking for a week. Do the 10 minutes of exercise while adding one minute daily. See what that does for you. You want 20 chicken breasts? Eat them. You want zucchini, yellow squash, any other carbs except fruit? Eat them. Lots of them. Don't even count carbs from veggies. Just count white carbs and limit those drastically to 20gms daily. The idea here is not to get you into ketosis, the idea is to get you eating the right carbs. Have unlimited VEGGIE carbs. You will poop like a champ, an added benefit.

I'll bet you that you lose weight.

Then as the motivation kicks in and the stomach hunger dies down you will be able to cut those 20 chicken breasts down to 10. Then 5, then 1 daily. Understand what is head hunger and what is true stomach hunger. Just focus on white carbs and minimal exercise. I will bet you it works.

If you can live the life and frustration as a fat person, you can do this. Being fat is MUCH harder than better food choices. Again, it is all perspective.

Just remember, you CAN do this, you have survived much much harder as a fat person and you have survived a life that is no walk in the park. If you can survive fat life you can easily survive the above plan for the next week.

And BTW, this means start the whole plan tomorrow, not on Sunday at the beginning of the week. If you have already eaten a load of carbs today you will be hungry for the rest of the day. It is a blood sugar thing. So start tomorrow and keep remembering, you can do this.

Good luck to you!

Not All Protein Is Created Equally

2010-03-11T17:02:00.000-08:00

Not all protein has the same value to your body. The amino acid profile is the reason for this. Proteins are made of amino acids, there are 20 different amino acids in the human body. Of the twenty, 9 of them must be consumed to meet your daily needs and these 9 amino acids are called Essential (EAA) or Indispensable.

The 9 EAAs are needed in certain proportions. A protein scoring system called Protein Digestibility Corrected Amino Acid Scoring (or PDCAAS) was developed to show which products contain all the EAA and in the correct proportions. It is supported by the FDA, the World Health Organization, and perhaps most importantly, the Institute of Medicine at the National Academy of Sciences. The highest possible score is 100.

-- Collagen Protein gets a 0 (the lowest possible score)
-- Whey Protein Isolate gets 100 (the highest possible score)

Some proteins such as collagen or HYDROLYZED COLLAGEN protein are missing one of the EAAs entirely. So the PDCAAS for collagen is zero. Collagen is often the main ingredient in protein supplements that come in a liquid form, and they usually have lower PDCAAS scores.

Here are some collagen products that have lower PDCAAS scores:

New Whey and Profect1: These products appear to have a PDCAAS score of 5 or 6 out of 100. Lab analyses of several samples suggest that about 94% of their protein, by weight, is from collagen.

Proteinex2: The Proteinex OTC products appear to get protein only from hydrolyzed collagen, so their PDCAAS score is 0 or virtually 0.

Pro-Stat 64 / Pro-Stat 1013: These products appear to have a PDCAAS score of about 37 out of 100.

The BEST products to purchase are products made from whey protein ISOLATE (not concentrate) and soy protein ISOLATE.

Protein Samples - Where To Get?

2010-03-10T17:50:00.000-08:00

This was posted by JennaKopanyi on www.obesityhelp.com

http://www.obesityhelp.com/member/jennakopanyi/

About Time Protein Products - 2 servings Total cost 2.99 http://www.shopabouttime.com/ProductDetails.asp?ProductCode=TrialPack

Unjury Starter Kit with Mixing bottle - 12 servings Cost 17.95+6.00 shipping http://www.unjury.com/store/protein/unjury-protein/unjury-starter-pack.html

Click Coffee Protein Drinks - Email them first about a sample and they will email you a half price code for samples and the instructions on how to use it. You will then get 2 servings for about 3.00 Total. http://www.drinkclick.com/shop.html

Bariatric Advantage Sample kit - They arent free anymore. it is 8.95 I dont remember shipping but is was some of everything they have for your surgery type. http://www.bariatricadvantage.com/catalog/itemHandler?id=1920

Chike Nutrition - You pay 6.99 shipping for 5 servings. http://www.chikenutrition.com/free-sample.html Celebrate Vitamins - Email form request and surgery type and they will send you a bunch for free. http://www.celebratevitamins.com/component/chronocontact/?chronoformname=sample

Bell Plantation PB2 - Peanut butter powder for shakes and cooking AWESOME! 3.99 shipping included. http://store.bellplantation.com/PB2-Chocolate-PB2-Sampler-p/spb2-cpb2-1d.htm

Building Blocks - Email them about samples, I think mine were free. http://www.bbvitamins.com/Contact.aspx

Syntrax Nectar 13 ct sample pack direct from the company is now $13.00 no shipping. Just call them at 866-333-7403. There is an option on the phone tree for bariatric. http://www.si03.com/

BJ Bariatrics - Nectar sample pack 12.92+5.00 shipping http://www.bjsbariatrics.com/mm5/merchant.mvc?Screen=PROD&Store_Code=bjb&Product_Code=synSamplePack&Category_Code=syn

Kaffree Roma - For those needing to get off coffee for a while or forever. Caffeine free and taste awesome. There product locater helps a lot most Martins carry it in the organic section. http://www.morningstarfarms.com/product_detail.aspx?family=3698&id=302

Designer Whey - Email them why you want samples and they send them. http://www.designerwhey.com/

Set Point Health - Email them why you want samples and they will send you a list of what is available and send them. https://setpointhealth.com/ws_setpointhealth/main/main.asp#

4Ever Fit - Email them that you would like to try the Fruit Blast Natural (truvia), the Fruit Blast the Isolate, and 4ever Whey Protein and why and they will send samples. http://4everfit.com/

Champion Nutrition - Email them that you would like to try the Champion Pure Whey and why and they will send samples. http://www.championnutrition.com/

GoTein - For $3.00 they will send you one Chocolate, one Strawberry, and one Vanilla protein serving. About Time Protein Products - 2 servings Total cost 2.99 http://www.shopabouttime.com/ProductDetails.asp?ProductCode=TrialPack

Unjury Starter Kit with Mixing bottle - 12 servings Cost 17.95+6.00 shippinghttp://www.unjury.com/store/protein/unjury-protein/unjury-starter-pack.html

Click Coffee Protein Drinks - Email them first about a sample and they will email you a half price code for samples and the instructions on how to use it. You will then get 2 servings for about 3.00 Total. http://www.drinkclick.com/shop.html

Bariatric Advantage Sample kit - They arent free anymore. it is 8.95 I dont remember shipping but is was some of everything they have for your surgery type.http://www.bariatricadvantage.com/catalog/itemHandler?id=1920

Chike Nutrition - You pay 6.99 shipping for 5 servings. http://www.chikenutrition.com/free-sample.html Celebrate Vitamins - Email form request and surgery type and they will send you a bunch for free. http://www.celebratevitamins.com/component/chronocontact/?chronoformname=sample

Bell Plantation PB2 - Peanut butter powder for shakes and cooking AWESOME! 3.99 shipping included. http://store.bellplantation.com/PB2-Chocolate-PB2-Sampler-p/spb2-cpb2-1d.htm

Building Blocks - Email them about samples, I think mine were free. http://www.bbvitamins.com/Contact.aspx

Syntrax Nectar 13 ct sample pack direct from the company is now $13.00 no shipping. Just call them at 866-333-7403. There is an option on the phone tree for bariatric. http://www.si03.com/

BJ Bariatrics - Nectar sample pack 12.92+5.00 shipping http://www.bjsbariatrics.com/mm5/merchant.mvc?Screen=PROD&Store_Code=bjb&Product_Code=synSamplePack&Category_Code=syn

Kaffree Roma - For those needing to get off coffee for a while or forever. Caffeine free and taste awesome. There product locater helps a lot most Martins carry it in the organic section.http://www.morningstarfarms.com/product_detail.aspx?family=3698&id=302

Designer Whey - Email them why you want samples and they send them.http://www.designerwhey.com/

Set Point Health - Email them why you want samples and they will send you a list of what is available and send them. https://setpointhealth.com/ws_setpointhealth/main/main.asp#

4Ever Fit - Email them that you would like to try the Fruit Blast Natural (truvia), the Fruit Blast the Isolate, and 4ever Whey Protein and why and they will send samples. http://4everfit.com/

Champion Nutrition - Email them that you would like to try the Champion Pure Whey and why and they will send samples. http://www.championnutrition.com/

Signs of Emotional Eating - Eye Opening List

2010-03-10T10:21:00.000-08:00

I stole this (with permission) from Prek-3 on www.obesityhelp.com. It is so good and so on target I really wanted to incorporate it in this blog:

Eight Signs of Emotional Eating

A lot of people ask, "How do I know if I am over eating for emotional reasons?" If any of the following statements sound like they could apply to you, then it's likely you are struggling with emotional eating.

1. My hunger comes on suddenly. Physical hunger comes on slowly. Hunger from emotional eating often comes on quickly and suddenly.

2. I crave specific foods-generally not carrot sticks or steamed broccoli. Cravings for specific foods usually unhealthy foods are signs of emotional eating. Often people like the rush they get from satisfying their cravings. The rush is fulfilling emotional hunger.　

3. My hunger feels urgent- I need a particular food right away and I am willing to walk out of my way, or get in your car late at night, or raid my kids Halloween candy to get it. Physical hunger, unless you haven’t eaten for a long time, is usually pretty patient. It will wait for food. Emotional hunger demands to be satisfied immediately.

4. My hunger is often paired with an upsetting emotion- if I backtrack a few hours or a few days I’ll usually find an upsetting event and feeling that triggered the urge. Hunger thats comnnected to an upsetting emotion or situation is definately emotional hunger. Physical hunger is not typically triggered by emotions.

5. My eating habits involve unconscious eating- all of a sudden I’m eating ice cream and I find the whole contianer is gone.

6. I don’t stop eating in response to being full- I keep wanting more of the taste of the food. Physical hunger doesn’t need to be stuffed in order to be satisfied. Emotional hunger on the other hand often demands more and more food to feel satisfied.

7. My hunger isn’t located in he belly- I crave the taste of a certain food in my mouth or I can’t stop thinking of a certan food. Feeling hungry in this way is usually a sign of emotional hunger or binging. Physical hunger is happy to get what it can, while emotional hunger usually focuses on specific tastes and textures.

8. After I satisfy my hunger, I am often filled with a sense of regret or guilt- Feeding your body what it needs is not something to feel guilty about. If you feel guilty after you eat, it’s likely because part of you knows you’re not eating just to satisfy physical hunger.

When you’re eating for phyiscal reasons, you are usually mindful of what you’re doing. If you catch yourself eating, “just because”, then its likely you’re eating for emotional reasons..

Pre Op Diets, Are The Necessary??

2010-03-09T19:45:00.000-08:00

Pre op diets, are they necessary?

In a word, yes.

Now, this is a pet peeve of mine. Liquid pre op diets. Someone out there please show me where a low carb liquid pre op diet is superior to a low carb solid food diet! I want to see the peer reviewed studies. I have searched for years and not found a single one!

Doctors talk about LSD or Liver Shrinking Diets. Want to know the real truth? The real truth is that in order to actually shrink your liver it takes weeks, months for your liver to shrink in size. BUT... what an LSD does do it absorb the glycogen from the outer surface of your liver.

When you eat carbs they are converted to glycogen. Glycogen is stored in and on the surface of your liver and in your muscles. When you go on a low carb diet (liquids or solids) your body absorbs the glycogen. Glycogen on your liver is like .... well, snot. Slippery and slimy. It makes it more difficult for your surgeon to hold your liver out of the way when he's working on your stomach. When you do low carb your liver may not shrink in 2 weeks but it will absorb the snot on the outside of your liver making surgery easier for him. If it is easier for him it is safer for you!

I am not an advocate of low carb liquid diets. People don't follow them, they cheat. If you give someone a diet that will do the same thing and they aren't starving to death and dealing with huge food issues, they are more likely to follow the diet. What is more important? Following a stupid liquid low carb diet where you will cheat or following a low carb diet that does the same thing and you actually follow it? My own personal vote is the diet you will follow.

I am not suggesting you break the rules your surgeon set for you. What I most certainly am suggesting is that you ask your surgeon for peer reviewed journal articles showing that a low carb liquid diet is superior to a low carb solid foods diet. He won't have them. Some say it is to clean your intestines and colon pre op. To that I say.. nonsense! Most people become very constipated on a low carb diet. There is no fiber in low carb foods.

He is likely to come back with... Well, it works for us. Tell him fine, HE can do weeks of liquids. Why do you need to do so? What is the value. And I'm here to tell you, those that do a week or two of liquids are no more prepared for the post op diet. It's just a longer amount of time to be on liquids.

I honestly don't know if doctors have a power issue going on or what when it comes to liquid diets. But it is a torture that is not necessary. Make him prove liquids are superior to solids. Low carb is low carb. Heck, a chicken breast has fewer carbs than a protein shake. Eating chicken breast will burn more glycogen than a shake that has carbs in it. Bleh to pre op liquid diets.

I feel so much better now that this is finally in my blog! It's my huge pet peeve on WLS.