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OK, so I figure this is my last resort. I don't know if it will pan out but it is certainly worth a shot. I work for a large heath care company (the largest in the US) HCA. I have cigna ins through them and it does cover WLS. I in fact have been approved and have a date of 1/26 to have RNY done in Ocala, FL. Since my approval I discovered the DS and really want to switch to this WLS. Here are my issues.

My ins (Cigna PPO) only covers DS for someone with a BMI of >50 (contrary to what I was told on the phone). My BMI is not that high (41). I have had some encouraging advice though and think that this obstacle can be overcome.

2nd There is a wonderful MD available to me here in FL. Dr Michel Gagner. He however is not contracted with Cigna (yet). I am told it is in the works and sometime eventually (who knows when) he will be able to accept CIgna.

3rd Cigna PPO through HCA specifically says WLS of any type has to be done at an HCA facility. Period. There are no hospitals in FL at all (that I can find anyway) that have an MD that does DS.

I am willing to go out of state. I have found an HCA facility in Denton, TX.  I emailed and am awaiting a reply.

I am really getting into anxiety mode here.

OK, so I have been approved for RNY and have a surgery date scheduled for 1/26. I just found out about DS and have decided that this is the surgery for me. Although I am not superobese (BMI 40). I have diabetes and was started on insulin at 18 y/o. This is my primary motivation for having WLS. In the relitively small amount of research I have been able to do the DS has a much higher cure rate for diabetes than the RNY. Also it seems that long term the outcomes seem to be better. I called my ins. company this am to see if the DS was covered. The lady on the phone was very nice but didn't seem to know what she was talking about. First she said no then she said wait a min and read some more. She finally did say that in fact the DS was not covered. When I asked some more ?s I found that the surgery is not listed as excluded. It just isn't listed. I have read a few posts here that seem to imply I can make this happen with my ins company. So my new mission begins.

I have been working so hard to make this happen for so long.  I was so excited to get the news that I was approved for surgery. Thanks to a very popular and controversial post about DS on the RNY board I have been exposed to alot of information that I was totally ignorant to. I am sure it is too late to change my mind now. I am angry at myself for never researching more and becoming familiar with the DS. From what I have read tonight this is the surgery that would be best for me. I kindof wish I would have never read that damn post. I was so sure, so confident in my decision. Now I am starting to think it was the wrong one. And related to pure ignorance. Arghhh!!! I am so frustrated. So what now. Do I start all over. Call my ins comp and fight with them. Find a reputable Dr. in  FL. (mine does not do the DS). What to do, what to do?????

I had made up my mind. After my husband's company changed to an  insurance company that did not cover WLS (3 months into my 6 months of medically manages diet), I was devastated. I was crushed really. So, I decided dammit! I am going to have this surgery one way or another. I did a lot of research and after considering multiple countries ( India, Thailand, Costa Rica, and Mexico) I decided on Mexico and then finally on Dr. Joya. I worked so much overtime in the months preceding my anticipated surgery month (6/08). I did save the $ and was ready to go. Then I found a new job with much better hours and an insurance plan that did in fact cover WLS (Cigna PPO). My family and I took a vacation to CA and we spent the $ I had saved on some much needed dental work for my hubby.

 I started immediately after beginning my new job on the 6 month medically managed diet. program that is required by the insurance company. While I was insured through my husband's insurance (before the change of ins companies) I had chosen an MD and a hospital, and I was very happy and comfortable with that choice. Unfortunately there was only one choice of Md's and hospitals with my new insurance. I was forced to take Dr. Jawad as an MD and  a hospital over 2 hrs from my home.  I had read and heard wonderful things about Dr. Jawad and was comforted by that. I being a skeptic though decided that I would form my impression of him when I met him at the new patient orientation.

I scheduled my new patient orientation a total of 3 times. The first time I canceled because it would have required me to be away from my husband for a day while he was on leave. I see him so infrequently that I decided I would reschedule for a day after he went back to Iraq. I know its only one day but it broke my heart to think I would miss just one day with him while he was home. The day before my rescheduled  (2nd) appointment I hurt my back. I was in terrible pain. I had a hard time walking and was in tears when I did. This is nothing new. It has happened before and a few chiropractic treatments and I am good as new. My chiropractor forbid me from driving the 2+ hr drive to the Dr's office for my orientation. So I called to cancel and reschedule. I was informed then that if for some reason I could not make this third appointment I would be disqualified from having the surgery. They would not make another appointment. I found this odd. I had every intention of keeping my other 2 appointments and then life happened. What can you do? The three strikes and your out rule was weird though. They get paid for me to come. Why would they tell me I can't. Even if I had to reschedule 4 or 5 times what difference is it to them.

I anticipated my third and final appointment with dread. What if something happened? What if I can't make it for some reason? While waiting for my patient orientation I went to my final weight loss visit at my Md's office. I am so very fortunate to have a wonderful family Dr. He is so supportive. I was so excited that day. I could relax a little. The hardest.....er....well.....at least the longest part was over.

I showed up to my new patient orientation at Dr. Jawad's office on 11/21/08. Six months of diet progress notes in hand. :) I entered the office and noticed it was very large. Much larger than I imagined from seeing the outside. There were many extra wide plastic fabric covered chairs arranged in a circle in the middle of the room and along the outside walls. Lots of local magazines but I didn't notice anything like an obesity help magazine. I thought that odd. There were several posters on the walls diagramming RNY and stating the percentages of improvements of health problems. The only reference to the lap band was a plastic stomach at the reception counter with a demo lap band on it. There were several people already there. And several more arrived after me. I had to use the bathroom while I was waiting for the meeting to start. I walked through the door heading into the office. Directly in front of me was a large beautiful pond. The sound of water trickling over rocks was nice. There were quite a few very large (over a foot long) Koi and turtles hanging out on the rocks. You don't see that in a Dr's office every day. I was impressed by that. The 12:30 meeting started at 1pm. I expected to go to a room or.... well....somewhere. But, we just stayed in the waiting room.

The first lady to speak was Sandra. She is the new patient coordinator. She is the person who scheduled my appointment and told me the 3 strikes and you're out rule. She started by filling us in on some basic practice information. She also gave us a basic understanding of the process (insurance, FMLA, etc.). She also let us know what to expect for the orientation day. One thing she mentioned that made my ears perk up was that, and I quote "everyone here works on commission". What!  like a car salesman or something. I thought this was very strange. It explained the 3 strikes and you're out rule though. She has to have a room of people to orient or she doesn't get paid. Hmmmmmm. Remember I am a skeptic.

She then introduced the other Sandra (Sandra Denton). She is the Dr's ARNP. And according to the 1st Sandra she is Dr. Jawad's right hand woman. Sandra ARNP then turned our attention to the TV. She showed us pictures of all the staff and described their duties. She also mentioned at this point that the 1st Sandra was a post RNY patient and showed us before pics of her. I thought it strange that the 1st Sandra didn't share that herself. Then with the visual aid of a slide show on the TV she went into great detail about the statistics of dieting. She followed that with a very detailed description of the RNY and its benefits. Following there was a very brief description of the lap band using that plastic stomach I spoke of earlier as a visual aid. The Lap Band was never spoken very highly of. It was actually discouraged. In fact she said she had only ever seen one patient that was able to take off 100% of their excess body weight. I definitely got a feeling that the office was not too pro Lap Band. After that a brief description of the gastric sleeve. I thought this very unnecessary and a waste of time since they had already made it clear this surgery was not covered by insurance (self pay only) and had determined through a group question that no one had any intention of having this type of surgery. 

Finally there was a question and answer session. I kept wondering when the Dr was going to show up. I was excited to meet him and ask him a couple of questions. I got a little upset when she said we would not be meeting Dr. Jawad. I was informed that we would not meet him till the preop visit. What!!!  So I am supposed to go through the process of getting an approval for a surgeon to do a major rearranging of my plumbing before I ever meet him. Is this legal!?!?! I am getting really nervous here. I am being forced to use a Dr that I am becoming increasingly uncomfortable with( or at least of his office practices). I remember being a little nauseated at this point. This is a huge decision. The insurance company has taken away my ability to choose. Once the Q&A was done they called back people into individual rooms in the order that they had arrived for the meeting.  

While I was waiting I had an opportunity to speak with the girl who arrived just before me (therefore she would be called back right before me). She was a lightweight in comparison to some. I was actually surprised she was even there. She was really nice and told me she was interested in getting the Lap Band. I learned that she had not been heavy all her life ( gained it all after childbirth) and I doubted highly that she was 100 lbs overweight. With that info I really thought the Lap Band just might be the right thing for her.

She and I were called back at the same time and were placed in rooms next to each other.  I cracked my door a bit to see what was going on. According to the 1st Sandra normally a girl named Odalys would normally visit us each individually to talk about insurance requirements first. Followed by Sandra the ARNP who would eval us and answer any medical questions. Odalys, however was on vacation. So the 1st Sandra would be fumbling through Odalys's part of the process. I was really disappointed because a lot of my questions were in regards to insurance.  I heard the 1st Sandra go into, and a short time later come out of, the girls room who wanted the lap band. Then I heard Sandra the ARNP go in. A few minutes later I heard Sandra the ARNP come out and say  happily (as if she had made a sale) "I got her". That is all I heard. I know that I may be jumping to conclusions here but it seems to me that they had changed this girls mind to have a RNY instead of a Lap Band. Was that Sandra the ARNP's quota? The girl was gone before I left so I never got a chance to ask.

Soon after that the 1st Sandra arrived in my room with a couple of pieces of paper. They had my particular insurance's requirements highlighted. As I expected she couldn't answer any of my ?'s because this was not her normal job role. She left and Sandra the ARNP arrived. She asked me a couple of ?'s. And did a brief exam. The I started asking her ?'s. For Dr. Jawad's right hand woman I was surprised that she couldn't answer many of my ?'s.

Q1  It was made very clear that you had to be off of birth control pills for a couple of months before surgery. I am on the birth control injection Depo Provera. Is that OK?
A1 She didn't know the answer and suggested I ask Dr. Jawad.

Q2 How much of the intestine is bypassed?
A2 same as A1

Q3 Is the anastamosis (connection) between the pouch and the intestine made with a circular stapler or hand sewn?
A3 same as A1

Q4 What tests are done to detect leaks?
A4 same as A1

There were more but you can kinda get the picture here. Sandra ARNP is a very funny charismatic lady. I enjoyed listening to her teach. When I asked her very specific questions though she was lost. For a right hand woman, and the person who will be assisting my surgeon I was unimpressed.  I made it clear to Sandra ARNP that I was insistent on meeting the MD prior to pre op. Regardless of her inability to answer my questions I would have insisted on this request. She informed me that Dr. Jawad did not typically meet with patients prior to pre op but I would be able to schedule another appointment to speak with him. She then gave me some Rx's for my labs, psych eval, and nut eval. I noticed my name was spelled wrong on the scripts so she left to correct them. She returned a few minutes later with "great news". The Dr. just stepped into the office and will be able to meet with me.

Dr Jawad entered my room a few minutes later. He was quiet and rather stern looking. Not much for facial expressions. I thanked him for taking the time to speak with me. I then started asking the questions I wanted answered. He answered all but one to my satisfaction. When I asked about how the anastamosis was made between the pouch and the intestine he kind of dodged it. He gave me an explanation that I didn't understand and I told him that I didn't understand. He then told me to watch the video of a live surgery on his website.  At that point I thought I had pushed the issue enough.  I know I had watched the video previously but thought to myself maybe I did not watch closely enough to understand how that connection was made. I was not satisfied with his explanation ( or lack of ) regarding this. I kept thinking he didn't understand what I was asking him. I went so far as to go to a poster on the wall to help to illustrate my question. By the way, the reason I am so concerned about how the connection is made is related to the possibility of leaks. The circular stapler reduces the possibility of a leak at that connection. A leak is one very preventable thing that will kill you if it happens. The one other concern that I had was when I asked about a barium swallow study to test for leaks the day following surgery. He said that they check for leaks by giving you blue dye and watching for it to show up in the drainage tube that comes out of the abdomen. I am not satisfied with that. I will insist on a radiology study which will be a much better indicator of a leak. With that I thanked him again and was on my way. The whole thing took me about 4 hrs.

I double checked with my insurance company to make sure this was the only option I had as far as surgeons. This only validated the fact that if I was to have surgery it would have to be in Ocala with Dr. Jawad. If you look up his profile on OH you will see rave reviews. Many of them. I work with two people who have had surgery with him and they can't say enough good things about him. Maybe I am too critical or skeptical. I don't know. I do know that used care sales tactics or not, this man has done thousands of successful surgeries. I have no other choice. This is the man who will be my surgeon.

Within 2 weeks after my orientation I had completed all the requirements of my insurance company (remember I had turned in documentation for my 6 months of medically managed weight loss program on orientation day). This included a psych eval, labs, and a nutritional eval. I checked to make sure the office had received all the documentation, and they had. Soon after I called to check the status and was informed that my paperwork had been submitted to my insurance company.  Now we play the waiting game. I will note here that I tried many times to speak with Odalys, the insurance person. After multiple messages over several days and no return call, I guess I bugged them enough to let me speak to her. I was concerned because in the paperwork that was given to me on orientation day it said that all the progress notes over the six months must include a current weight, a diet plan, and an exercise plan. I noticed from my copies of my notes that exercise was only noted on one of the six progress notes. I was concerned about this and wanted some guidance. Did I need to have my Dr amend the notes or write a letter stating we had in fact discussed exercise? When I finally was permitted to speak with her she told me to just sit tight and see what the insurance company said first. We would work on it if and when I got a denial letter. I was sure I would get denied because of this.
On Dec. 20th I received a letter from Cigna. I thought it was just another explanation of benefits. I honestly didn't even know I would get a letter from them regarding my request for RNY. I thought I would just get a call from the surgeons office. I opened the letter and had to read it like 3 times.

"Your health benefit plan requires some services to be reviewed for approval. We received a coverage request on 12/11/2008 for you for the following service(s):

*Approved: Laproscopic Gastric Bypass (43644)

After review of the information submitted, and the terms of your benefit plan, we have determined the requested service(s) will be covered. Your request had been approved for the above listed service(s) if you are enrolled and eligible for benefits on the date(s) of service. "

OMG!!! I am approved for the surgery. I was excited and nervous and scared. I wanted to scream but I cried instead. Wow!!! This is really going to happen. I truly thought I was up for a fight. I expected a denial letter. I wanted to tell my husband but of course that would have to wait. I was so excited that after all these years of trying and planning It was happening. I was so scared and nervous because I was having the surgery done with a surgeon because he is the only one my insurance company will pay for. This was truly mixed emotions. I have never felt that way before, such a messy mix of emotions.

Now all I need is a surgery date. Then this will be real. I got the letter on a Sat. so would have to wait till Monday. On Monday morning I called first thing. I got no answer. Not an answering machine or service or message of any kind. Just no answer. I thought that was weird. I called again and again. I checked the number on the website to be sure it was right. I continued to call throughout the day and finally got the answering service that afternoon. I was informed that the office was closed for  for the entire Christmas week. They had forgotten to tell the answering service though.  ARGHHHH!!!  Two things were going through my head. 1st, dammit, I have to wait an entire week before I can find out a surgery date. 2nd what if I were post op and having a problem. I tried to call that office all day long with no answer. Obviously this would not be a frequent issue, but how irresponsible.

On the Monday following (12/29/08) I called and was informed I needed to speak to Meagan the surgery scheduler. I got her voice mail (surprise) and left her a message to call me back on my cell phone. I worked all day and I share an office with another employee. I have not told anyone at work yet. I was afraid she would call me back while I was in my office and it would be difficult to be discreet. I actually explained this on her voice mail. What I decided to do was call on my breaks to try to have a chance to speak to her openly. After multiple calls I was finally permitted to speak with Meagan. She sounded annoyed that I was so persistent. She said she left me a message on my home phone. I had specifically left a message for her to call my cell. I hardly ever use my home phone. Anyway we spoke and both agreed on a surgery date of 1/26/09. I will be going in for an all day preop visit in Ocala on 1/22/09. I was informed that I had to bring someone over the age of 18. When I asked "why" I was told mostly for witnessing purposes, which made little sense to me.  Also ideally the person you bring would be the person who would be helping you post op. I explained that my husband would be helping me but would not arrive by the 22nd. She told me that it didn't really matter who it was as long as they were over 18. I am a little nervous about what to expect that day. I guess I will figure it out when I get there.

There it is. I have a date. It is official. I am going to be a changed woman soon, leading a different life. Now my life is absorbed with all things RNY. I have become active again on OH. I am researching different products and supplements. I ordered tons of protein samples. My husband will be able to come home to be with me for 20 days. That is such a relief. I really have little to no support. No family and a couple of really busy friends. So here we go. As my husband says "it is what it is"

:)

Ok so here I am vasselating over what Mexican surgeon I will be using. ( Hee hee theres a $10 word) So in my last post I was leaning toward Dr Joya.......well I have vasselated my large posterier to the other side and am now leaning more toward Dr Valencia. This is based mostly on the experience that he has. I know at some point he was a member of both the asbs and sages. Though I cannot verify that he is anymore. I suspect that is because he has recently moved to his home of Mexico to start a practice and it is no longer neccesary to keep the expensive titles neccesary in the US. Any way I will verify all this and much much more on Monday when I speak with him personally. I am so excited. This is a bit impromtu but I will list my ?'s and after I speak with him I will list his answers.

UPDATE: On 3/12/08 I received a call from Dr Salvador Valencia. He spent over an hour on the phone with me. He was very patient and thorough. Never once did I feel rushed or that I was in any way bothering him. He was happy to answer all my ?'s and actually seemed pleased that I was so interested in my care.  Following each of my questions is Dr Valencia's answer. I have summerized his answers so not quotes word for word but in general what he had to say.


1. Are you or have you been a member of ASBS or SAGES?  If not now then why?

- I am currently a member of the Fellow of the American College of Surgeons (FACS) and belongs to the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), I have applied and am waiting for membership into the American society of bariatric surgeons (ASBS)

2. How is the surgery performed. i.e. Do you stitch the defect in the mesentary caused by the surgery to help prevent internal hernias? Do you hand stitch over the anastamosis made at the pouch? When performing the jujunostomy portion of the surgery do you staple the intestine in both directions creating a larger opening and therby reducing the risk of stricture? It is my understanding that you staple all openings and use a circular stapler to create the anastamosis at the stomach, is this true?

- Use a teqnique developed at UCLA called u-loop. All openings are stapled. There is no hand stitching so the risk of human error is greatly diminished. A large 6 cm stapler is used at the jujunostomy to create the opening so there is only stapling in one direction. Apparently the method he uses is different I think he called it the anti colic approach. he said this way there is no defect caused in the mesentary. According to Dr V the UCLA bariatric surgery dept. has done ever 1000 Lap RNY'd and have had no leaks or deaths.  There is an illustration on Dr V's website of the U Loop method of RNY www.obesityfreenow.com

3. Do you perform an elective cholecystectomy? Does there have to be evidence of gallstones? Or, do you prescribe ursodiol for 6 mo's post surgery to prevent cholecystitis? Or is this just not addressed?

- Dr V said if there is evidence during the surgery that there are gall stones and consent was obtained he would perform the cholecystectomy. There would be an additional hospital cost of about $400.00-500.00. He would only reccomend if there is evidence of stones and suggest if possible getting and ultrasound of the gall bladder prior to surgery.

4. Is there a upper gi performed following surgery? ( I will not have the surgery w/o an upper gi afterwards.) 

- Dr V does not typically do an upper GI / barium swallow study after surgery. He says that there are instances when leaks are not detected on them. What he does do is a test during the surgery so that he can visualize himself. Once all the connections are made he clamps the small intestine newly attached to the pouch and inflates with air. He also tests by pushing methalyn blue dye ( surgical dye) under pressure through the pouch and into the clamped intestine. He feels certain personally visualizing is best method and is superior to an upper GI.  He also said that he would order the test if I decided to have it.

5. Do you have a nutritionist or psych that I will see prior to surgery? If so will they be available to me once I go home?

- A nutritionist is available preop and immediate post op. Dr V strongly suggests finding a nut and psych locally for a support system post op.

6. Is there a liquid diet before surgery. If so, can I have solid food once I get to Mexico ( I really want to try real mexican food and I will be arriving a few days prior to surgery.)

- Dr V would like me to have a high protein liquid diet for 5-7 days pre-op as far as dinner in MX, he said that is fine as long as I follow the liquid diet for the week prior to arriving in MX.

7. As far as the diet after surgery, how will instructions be provided to me? What if i have ?'s Also what liquids immediatly post op can I have. ( I want to bring some things to have in the hotel)

- A complete guide to the expectations of diet post op will be provided. A nut will be available for ?'s and guidence post op.  The stages will include clears x 1week then mushy and finally solid. Dr V suggests bringing the clear protein bullets to use immediatly post op. Any other supplies can be purchased at the local Ensenada Wal mart.

8. What type of protein drinks are reccomended and when do I start them? I have an intolerance to whey protien. ( it makes me feel ill) Is it possible that that will change after surgery? If not what other options do you suggest.

- As stated above protein drinks are started immediatly after surgery. As far as suggestions, other than the 42 gm protein bullet none were made. He only suggested sampling till I found one I could tolerate.



9. When can I safely have intercourse after surgery?

- As soon as I feel comfortable. There really are no restrictions. 

10. How long off of work?

- Depending on how I feel, at least one week, up to two weeks.

11. What about follow up care? What labs are to be done when? What vitamins? Do I need to bring them to mexico? I want to do b12 injections. Do I need an Rx? Can you give me one?

- All specific instructions will be given after surgery. All follow up lab work and any RX's will have to be handled by my primary MD. These things should be discussed with my MD. Having a Dr that will be supportive is important.

12. What ?'s should I ask my Dr. at home?  Would you be willing to speak with my  Dr. ?

- Ask your md if he is familier w/ bariatric patients and followup care. Be sure he/ she is supportive of decision and will be willing to f/u w/ labs and meds as needed. Dr V said he is more that willing to speak with my Md and actually encourages it.


13. Are there any dietary modifications that need to be made because I work nights. I also switch back to a day schedule when I am off so my week is half days half nights. 

- No modifications are neccesary, just follow the diet.

14. I take fish oil. Can or should I continue to take it?

- Should be no need to continue taking fish oil.

15. What prescriptions or medications will be provided to me post op? Is there any problem taking them across the border back to San Diego?

- Medications (pain) will be dispensed to me. ( forgot to ask about border crossing) I will need to stay on prilosec for at least 2 months following surgery. I will need to be crushed.

16. I have TED hose ( anti embolism stockings) should I wear them to surgery? or after? or when? or not at all?

- Highly encouraged to wear. Particularly after surgery and on plane ride.

17. What hospital do you use? What course of treatment can I expect there. i.e. will I be staying in an ICU, tele, or med/surg floor? What are the staffing ratios? 

- Forgot to ask about hospital, but have emailed him w/ that ? After surgery I will be monitored on a medical floor. Dr V and his associates will be checking on me several times through the day.

18. What meds are provided for pain control in the hospital? Are there alternitives if what you prescribe doesn't work? Are there standing orders or will you need to be contacted from the hospital? Will I be given antibiotics pre, during, or post op? If so, what kind?

- Pain meds are provided and will be changed if ineffective.  Dr V was not able to give me the american name of the med used other than Ketorolac (toradol) a non narcotic  med. Pain control is handled by his brother the anesthesiologist. Dr V did tell me that Morphine is not available in MX but the narcotic med they use is in the same family. 3 doses of anibiotics are given 1st 1 hr prior to sugery and 2 more following.

19. How many bariatric mortalities have you had? If any, why, what happened?

- No mortalities

20. How much intestine is bypassed, and why? Is more better?

-100 cm is bypassed. This is the standard in Bariatric surgery.

21. What preop tests are done? Can or should I have any tests done here in the states?

- typical pre op labs are done. The labs that can be done that will not need to be repeated are a tsh and lipid panel. ( to be honest though all these tests are included in the price and I am sure price will not be adjusted f or any lab work done on the states.) Dr V does suggest if possible to get a gall bladder ultrasound, so that it can be removed if neccesary.

22. How long after surgery can I swim or go into the hot tub?

- at least a week if stitched but if surgical glue is used and all openings are completly closed there is no restriction.

23. How are the openings closed?

- 2 methods are used. Plastic surgery stitching that doesnt have to be removed or surgical glue.

24. Will I have a drain after surgery? If so, how long?

- no drain is used

25. Do you have an anesthesiologist that you use or are they provided by the hospital? In other words, do you know the anestheiologist and are you familiar with his/her work?

- Dr V is very familier with his anesthesiologists. He has 2 the 1st is his brother and his brothers partner Dr Garcia.

26.  Will I meet with the anesthesiologist prior to surgery?

- I will meet with Dr V's brother or Dr Garcia prior to surgery and they will answer any ?'s then ( Pain control?)

27.  What size stomach pouch is created?

- 60- 80 cc

28.  Do you cut the acid prodicing nerve to prevent ulcers? Or do you prescribe and antacid?

- The nerve is cut when the stomach is dissected.

29. How long does the surgery last typically?

- 2 hrs

30. Will you or someone update my husband as to progress and how the surgery went?

- Yes, somone from the team will be updating my husband during and after the surgery.

31. Typically how long am I in recovery? Can my husband and children see me there?

- did not ask this ? Apparently children are typically not allowed in the hospital rooms. This is an issue that I will need to clarify with the hospital.

32.  Will i have IV's, IV fluids, foley cath, and/or NG tube?

- IV's and IVF"S are given, foley cath is only put in if neccesary, and an NG tube is not used.

33.  Will I need and abd binder and if so is it provided?

- Not provided or prescribed but I may use if it makes me more comfortable.

34.  How soon after surgery will I be taking liquids?

Depending on the surgery time either the evening after surgery or the following morning.

35. Will I be in a private room?

-yes

36.  How long is the stay typically, and are there any requirments that have to be met first, i.e. do I need to have a bm first?

-stay 1 or 2 days in hospital, no poopie neccasary for discharge.

37.  How long am I to stay in a hotel after surgery and will you or someone be checking on me there or do I need to go back to the hospital to have check ups?

- I will need to stay an additional 2 days after d/c from hospital before flying home and Dr V will be checking me in the hotel.

38.  What situation would cause you to do an open procedure? How often have you converted to and open procedure and why?

- never had to open, very rare

39.  Will there be medications that I can no longer take post-op, or medications I won't absorb normally?

-no

40. Are specific dietary instructions given post op. i.e, expectations for daily protien, fiber, fat, carbs, calories, and fluids? 

- yes detailed instructions will be given

41.  Are there any specific foods I should not consume post-op? ever?

- carbonated beverages because they could stretch the pouch. If you have to have a diet soda let it sit out and get flat first.

42. How often should I get weighed?

- personal preference

43.  What types of exercise do you recommend and at what stage post-op?

- Dr V reccomends starting now. And he says walk walk walk.

44. How can this surgery affect health problems I might develop later? cancer (treatment), need for stronger meds for arthritis, osteoporosis, etc.?

- according to Dr V there is no strong evidence to suggest this as being a problem.

45. Is there any risk of cancer or other problems in the bypassed portion of the stomach?

- Again no evidence to say you are any more likely than non bariatric patient.

46. How will these be detected post-op?

- signs and symptoms as with anything

47.  How often have you had a patient w/ a stricture? Is there anything you can do in surgery to help prevent this? What if I get a stricture, how will I get treatment?

- typically the anastamosis ( hole) made between pouch and small intestine is 1 to 1.5 cm. Dr V creates a 2.5  cm opening. This reduces the risk of stricture. If stricture does occur it will need to be treated here in the states as it is considered an emergency.

    I am getting so close to a final decision. I have now decided that I will be going to Mexico in June. Thank you to all who gave advice. My decision was based in large part on the comments made to my post. 
    As far as India is concerned, I have ruled it out for a couple of reasons. The 20+ hr flight after surgery with a toddler on my lap concerns me. Also another OH member who had her RNY done in India had only great things to say, but she did bring to my attention the fact that there is overwhelming poverty in India. So do I want to take myself and entire family to an impoverished country for a vacation of sorts, or do I want to go to a beautiful resort on the beach to recover and spend time with my family. Finally, I had a realization at work the other day. I work with alot of Dr's from India. It is my experience that women are treated quite differently in their culture. Rather subservient. I will be questioning everything. I want to know everything that has to do with my surgery and pre and post care. If for some reason I don't agree, I will say so. I will be in charge of my care. I am concerned as to how a male Indian MD would react to me and my taking charge of my care.
    I am still teetering between Dr's Valencia and Joya. Both Md's  have far more experience than any I have found in India. I am leaning towards Dr Joya, for 3 reasons. 
-First, he has many many great reviews on OH. So many people have raved about him. Dr Valencia also has good reveiws, just not anywhere near as many.
-Second, I have verified that he used the circular stapling technique that significantly reduces the risk of leaks. As far as I know Dr Valencia also uses this method. 
-Third, and certainly of least importance, Dr Joya's surgery is done in Puerto Vallarta. You recover in a beautiful resort on the beach. I think my family would enjoy the opportunity to have some fun on the beach while I am recouping. Dr Valencia does his surgeries in Ensenada. It is also nice but the city and accomadations seem, well.... just lacking in comparison. 
So there it is. I am one step closer on my WLS journey.