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Paul Cirangle (COE)
Look. You've committed yourself to a lifestyle change, to ending your obesity, and giving yourself freedom from the fat suit you've had wrapped around your skeleton for years. This is awesome. But stack the cards in your favor, and really research all the surgeons out there. Iím a career scientist, so reading papers and judging metrics are right up my alley, and thatís one of the reasons I picked Paul Cirangle as my surgeon. I was sleeved (VSG) last year; I got to goal weight in about nine months, losing 125 pounds. I actually lost 100% of my excess body weight, which is something most WLS patients arenít always able to do. I picked Cirangle for a few reasons. 1) My research showed he was one of the best sleeve surgeons out there Ė heís written papers (I can show you) that other surgeons use to learn how to properly shape a sleeved stomach. 2) If you look around here on ObesityHelp, and look at people that maintain 100% excess weight loss for many years, youíll see many are Cirangle patients Ė I noticed that, and I wanted that level of success! 3) Cirangleís surgery metrics are awesome. He sows a tight, effective sleeve but because of his technique and experience, doesnít usually suffer from complications like leaks. As him directly about his metrics and compare them to other surgeons. 4) And this one makes a huge difference, folks Ė his office staff is outstanding. They are along with you during your journey. Iíve called and e-mailed them a LOT, and they have always been welcoming and engaging. They remember who I am, they understand what itís like to be morbidly obese, and they stay with you during the journey. Many surgeon offices treat you like cattle, pushing you through the surgical line, but LapSF really does seem to care about the success and feelings of their patients. 5) Cirangle is really committed to aftercare guidance, and even now he still helps me develop skills for entering maintenance and remembers me and my journey. I feel like if I had chosen a different surgeon with a different office staff, I wouldnít have gotten rid of all of my weight. If you have more questions about Cirangle as a surgeon, please feel free to contact me directly. Iím really critical of surgeons and medical staff in general, but I cannot recommend this guy enough Ė heís helped turn my life around.
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Well guys -
Just wanted to relay my story of getting sleeved by Paul Cirangle this Wednesday on July 6th.† I have been overweight and fat all of my adult life, and I recently decided that after spending two decades modulating my weight, that that was an awfully long time to fail at something consistently.† Now, I had looked into WLS before, but I was never really thrilled with the malabsorptive effects of RNY/Gastic bypass and/or the DS surgeries.† However, earlier this year I was feeling particularly poorly regarding my weight.†† A couple years ago I was 320 pounds, I had dieted and exercised down to 210 pounds in 14 months, but I had now gained back a majority of that and got back to 280 pounds (I'm 5' 10").† I had started a new job, and thought about how all these new people saw me putting on this weight.† I even realized that in those two decades of weight-loss attempts, I had lost a complete total of something like 260 pounds, but I never weighed more than 320!† It always came back no matter what.† So even though I didn't like RNY or DS (or the complications and lower success rate of Lap Band), I decided to make a series of appointments with some local surgeons again, just in case.†
I met with Cirangle on June 10th, and was immediately struck by his factual candor, frankness, and intellectual directness.† I know others complain that he lacks a good "bed-side manner"; I'll always take a higher-skilled surgeon over a guy with a fake customer service face any time.† And having done my homework on Cirangle, he sure does seem to be one of the best, if not the best choice of surgeon on this side of this Mississippi.† His numbers are fantastic.† When I spoke to him, he explained to me how recently, late last year, many of the insurance companies stopped looking at VSG as an experimental procedure and started legitimately covering it.† I became hopeful for the first time in a while.† I thought of VSG as a tool, or buddy, to fall-back on for those days I would naturally have less than 100% compliance with my diet.† What benefits!† Little malabsorption, no dumping syndrome since the pyloric valve and ganglion is retained, and great hunger loss due to fundus and other ghrelin-expressing tissue being excised!† I heard VSG patients say they weren't hungry anymore, and it was almost boggling to imagine.
Well, I didn't waste a minute jumping through all the hoops.† I scheduled all my tests for as close as possible, back-to-back, and if my normal doctor couldn't fit the test in, I scheduled with another.† I had my psych consult (surprisingly the hardest to schedule), nutritionist consult, PCP cardio/surgical release, electrocardiogram (EKG), and upper GI series all done the next week.† Cirangle's business office sent off his letter, the nutritionist's and psych's consult off to my insurance carrier (Anthem BC), and amazingly, I was preauthorized in a week's time!† I must have been very lucky to have it covered so quickly.† (There were comorbidities that contributed to the petition.) ††A few days before the surgery, I started the clear liquid diet as ordered:† broth, tea, Crystal Light, sugar-free popsicles.† Fortunately, I was dieting using MediFast shakes before that, so the transition wasn't too painful.
My insurance carrier stated the procedure had to be performed at a 'Center of Excellence', so that meant Good Samaritan Hospital in San Jose.† We drove down to San Jose the day before the surgery on the 5th, and got hammered by the left-over 4th-of-July traffic; I guess some people made it a 4 or 5 day weekend!† We scoped out the hospital, and then just chilled in the hotel room for the rest of the evening.† At least, my partner relaxed; I fretted about, reconsidered my decision to have major surgery for the 1000th time, keep reloading and reloading ObesityHelp, and I think I practically gorged myself on sugar-free popsicles.†
After a mostly sleepless night, it was time to head over to pre-op.† I have to say, every single person I interacted with at Good Samaritan was polite, warming, and professional.† They did a lot to make me feel at ease.† I changed out of my street clothes, was measured, and asked a series of questions I'd be already 10 times already (just to make sure).† The pre-op nurse continued to work on my while a bariatric nurse (who had an RNY herself) came over to make sure I understand the reality of the eating change in store for me after the surgery.† She was great; and had a ton of great hints and tricks on where to find better pre-packaged protein, etc.† The anesthesiologist visited next, and then Cirangle visited, asking if I had any last-minute, unanswered concerns.† I just remarked that the only thought I had was I was scared but confident, and he replied that he would be worried if I wasn't scared at all.† Finally, his surgical nurse came with a last round of questions, and suddenly, it was time.
I walked to the OR (they have me walk to minimize potential bloodclots), and I hopped up on the tiny table, the anesthesiologist put the gas mask on me.... and then I was suddenly waking up in the recovery room in a great deal of pain.† Holy crap, I was in a substantial amount of pain.† No time seem to have passed, I didn't know how late it was, all I could do was moan and writhe.† There was some nurse working on my meds, and I kept communicating that I was in too much pain, but he told me to keep waiting.† Five or ten minutes later, Cirangle walks up to inspect me, sees how much pain I'm in (and to the best of my drugged recollection) starts yelling at the nurse for undermedicating me.† He said something like "he's a big guy and needs a bigger dose, and you can see how bad he's feeling, you need to bring his pain down".† †There was a brief discussion, Cirangle won, and I finally stopped feeling like my insides were treated to a weed-whacker.† Cirangle told me that he discovered a hiatal hernia, and while largely functional benign, he had to repair it for before he could create the correct shape for my stomach.† So I was in a bit longer than expected.
Got upstairs to my room where my partner was able to join me again.† Boy, those first few sips of melted ice chips were so difficult to get down... it's not that swallowing was difficult, it was just putting that tiny bit of water into my stomach first caused a bloom of nausea... each tiny sip would incite another bloom.† But it went away quickly, each swallow resulted in less discomfort and more relief as the evening went on.† Thank goodness for IV meds, is all I can say for that evening!† After the pain meds really hit me, I felt "just fine", demanded to start walking around and exercising, stood up and walked around too fast and nearly threw up.† Soooo, I slowed it down a bit after that, made sure I gave my body time to catch up when I stood up and moved around.
I slept.† The next day was better.† I got breakfast!† More of the liquid fast before my surgery.† I had my protein shake first (protein first!) and really had no room for anything else at the time.† I continued to walk, sip an ounce of water every 5-10 minutes, us my "breathing toy" to ensure my lugs stay clear and free of pneumonia.† Again, both the night and day nurse I had tending to me was just wonder; both great people that really helped me to feel better.† I had lunch, again, protein shake, and this time I could fit in some of the vegetable broth.† It was so delicious!† In the afternoon, a second bariatric nurse came to speak with me again about nutrition and supplements before Cirangle called to check on my compliance with keeping liquids down and taking my liquid pain medication before he'd be able to release me from the hospital.† I showed the nurse I had been doing both, so I was cleared to go home!† My partner got me home late Thursday evening.† I even had a check-up with Cirangle in his regional office the very next Friday (which was convenient, he made an adjustment to one of my med dosages).† Been recovering since then the past couple days.†
Taking Monday off, planning to go in Tuesday (I work a typical "fat" desk job).† No real nausea at this point, but my abdomen (from the punctures) and my shoulders (from the gas inflation) are still pretty sore.† I'm doing ok to keep about 70 g of protein in with 2 liters of water, but I feel _full_ doing so!† I hope swelling will continue to go down so I can fit another 20-30 g of protein a day in soon (nurses should be some good products that should help).
Well, that's my journey busted out of a nutshell!††† For background, I'm a partnered gay guy in California, big nerd and sci-fi/fantasy geek, and I run a science lab in a pharmaceutical company for a job.† Love to read, have a dog and two parrots.†