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Surgeon Testimonial

Alberto Aceves MD
***UPDATE***

I just had revision surgery and the only doctor I would ever consider going to is Dr. Aceves. I decided I wanted a sleeve procedure. I had it done 6/3/08 and everything was great! Staff were great, Dr. Aceves was wonderful, everything was perfect. Couldn't have asked for better care!!!



I had surgery 14 months ago. I intentionally did not write a testimonial until one year went by after surgery or until I met goal. Turns out, both apply here. I met my own personal goal at 10 months (-103lbs) and my other goal at one year, (-112lbs). I am done.

The reason I decided to wait was because I wanted to see if I would be impressed with Dr. Aceves after the fact as well as after surgery. When you have weight loss surgery the easy part is really the surgery. The hard part comes after that. I wanted to know how a doctor in Mexico would treat a US Citizen throughout the weight loss journey, not just at the time of surgery.

I am very impressed. My impression of Dr. Aceves 14 months after surgery is more positive than my first impression. When I met him for the first time at the hospital he made a special trip in to meet me as he was not at the hospital that day. But he knew that patients do not care to meet their doctor as they are being wheeled into the OR. So he came in to meet me.

He was warm, comforting, and almost fatherly. He explained the band, how it works, what to expect, what the rules are (no carbonation, etc.), and what we needed to do to be successful. He kept reminding me that this is a tool and it will not do it for me but it will help so *I* can succeed. He was right. Everything he said that day (and repeated again the following day and the day after that) proved to be absolutely true.

Overall I would give him an A+++++. He did a great job, he took very good care of me while I was in the hospital, he was always around, he came to visit me three times daily. He answered all my questions and provided me with not just a safe surgery, but a successful weight loss over the last 14 months. He has been there for me every step of the way as has his staff. Nina, Monica, Yolanda, Sergio, Karen, Lucy, Dr. Campos, everyone. They are great. They gave me every tool possible to use and there was simply nothing more they could have done for me.

They are all very warm and caring people that make you know they care about your health and your emotional state. They understand the frustrations and while they can't take the frustrations away of the weight loss process, they will hold your hand while you do it yourself. You really can't ask more than that from anyone.
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MidwesternGirl's Blog



GET MOTIVATED! You can do this!
on May 16, 2008 1:30 pm
(See advice to newbies below this)


I'm going to get hammered for writing this but that has never stopped me before. ;o)  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 band 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 don't give ourselves enough credit.  We think we are weak willed and powerless over the world.  That simply isn't 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's really damned hard.  Yet we survive it and if we can survive that, we can survive passing up a donut.  Let's face it, it is much easier to pass up a donut than it is to have to buy two airlines seats because our butts are too big for one seat.  It's much easier to pass up a single donut 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 WL.  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 a band or 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 don't 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 MO 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 verrry honest with yourself.  If you prefer the cake over thin then just go for it and have the darn band removed.  But I'll bet you'd 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 a band thin IS within grasp.

The thing about us fat folks is that traditional diet and exercise is too hard, we just can't 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'll cop to it, I'll be one to stand right up there and admit that I can't do it.  But with a band it is still hard but it is the kind of hard WE can do, OUR population.  Losing weight with a band is the kind of hard we can do but without a band, nope... we can't 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 can't play with razor blades in the middle of a busy street.  No, you can't eat rat poison.  No, you can't fail to look both ways when crossing a street.  No, you can't do drugs.  No, you can't go out with that drug abuser who just got out of juvvy.  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 can't stop at one Frito, or one bite of this or that.  For me it is all or none.  If I eat white carbs I can't 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 wasn't even something that tasted good (pretty rank, actually) but I couldn't 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 house.  You won't 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 don't 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 doesn't need them and he doesn't 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 don't load your cupboards full of crap your kids do not need.  I think that is another mindset we have to change.  I've seen people post on these very boards that they can't pass up the cookies in the cupboard but they can't 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... 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 don't 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? ;o)

There are people who LOVE exercise, zog 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. ;o)  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 thread on OH.  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's 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, don't count calories, don't count fat grams.  Don't 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'll poop like a champ too. ;o)

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'll 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's all perspective. 

What about your fill level?  Are you at good restricton?  If not, get thy butt to the doc and take care of it.

There, that's yer' butt kicking. ;o)  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's a blood sugar thing.  So start tomorrow and keep remembering, you can do this.

Good luck to you!
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My advice to newbies
on February 3, 2008 4:51 pm
People have been after me for a long time to add a profile. I didn't really journal my experiences during the weight loss phase, but I think I am going to write down information for newbies. I'm going to copy/paste/edit info I have written before in hopes that it will ease some fears and concerns we ALL have before and during weight loss. Much editing needs to be done on this so understand, this is a work in progress. I'm not done, there are typos, etc.

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.

The following is something I wrote to a person struggling with weight loss and are my own random thoughts:

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 pay 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.

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 workable with your band? 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 can 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? ;o)

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 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 after almost 15 months of banding 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!
25 comments | Click here to leave a comment.

My Story

How to research a Mexican surgeon (written for another board and cross posting here):

I make no secret of the fact that I did a LOT of research on a great deal of Mexican (and American) doctors 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 doctors. 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 doctors.

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

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


RESEARCHING MEXICAN DOCTORS 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 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. 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? Doctors 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 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?


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 doctors 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 doctors 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. 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 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 doctors 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 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. 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 doctors 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 doctors, they make it quite simple to research US doctors. For Mexican doctors you need to research by specific name vs. US doctors 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 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 100 patient testimonials or talk to at least 100 people about their surgery.

Do a www.LapBandTalk.com search on the name of the doctor you are looking at. Read it all. Do not ignore the bad, read it. If you have questions send the author a private message. There are two 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 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 doctors 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 doctors 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 doctors 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 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, 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 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.


Pre-Op Diets

It is common for doctors 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 doctors do not require the diet because it does not actually "shrink" the liver. 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. 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 doctors 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 doctors 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 doctors 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.

 


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