On another topic I was posting my brilliant musings about surgeons and pre-op diets and I wanted to say this because sometimes I'll answer a post and it will sound like I'm stating some authoritative opinion when I'm really thinking out loud.

I've been watching these boards for a couple of months and looked into getting surgery in my home state but it was very expensive. I knew it was going to be but then I realized the other thing I really did not want to deal with was six months of "pre-op" nonsense. I realized this when I contacted Dr. Aceves' office a second time and spoke to his patient coordinator, who was very direct but also very clear about what was truly necessary and what was not. In their practice. My pre-op is a week long lowcarb diet. I had to quit smoking ten days beforehand and start blowing up balloons. She told me about many other patients, their concerns, what could possibly come up, and why they needed me to do what they needed me to do.

Dr. Aceves has performed over 600 sleeves with very few complications as far as I can tell. I know of one rumored leak and then another phantom guy who came on here and said he almost died and that translates to a .03 serious complication rate for his sleeves. Yet his pre-ops are pretty lenient. I can use NRT. I did not need a psych evaluation. I put down my deposit, bought a plane ticket and was scheduled two weeks from that date. If Dr. Aceves were this lenient and he was sending people home half-dead, I would be suspicious. But he does appear to know what he's doing and there is a strong track record behind his methods so I'm happy to do what he tells me to do.

One other thing I noticed is that less people come around, online, on youtube, on boards like this and describe serious early or late complications of any kind if they've come from Dr. Aceves. Now either he is paying off his broken patients off or he is rolling the dead ones up in rugs and driving them into the desert for the coyotes -- OR more people are coming away pretty much whole when he is done with them. Which leads me to my suspicion about a number of surgeons in the US who are approveable by insurance: some of these people -- not all, I haven't done any data mining in this regard -- but unscientifically it seems some of these surgeons just have not done many sleeves and so they have to learn the hard way -- on us.

One way to mitigate potential disaster in that case is to make the patient's pre-op extremely rigorous. For example, a surgeon might say he can't operate on you until you lose ten percent of your body weight -- why is that? Because the literature and the insurance actuarial studies have said that this lessens risk by some margin, and it's possible that without certain patient requirements the hospital or the doctor will not be paid the insurance portion of the procedure. Also - surgeons work how they need to work - if he has learned to do the surgery using a 48 bougie on patients with very tiny livers who are under 45 BMI, these are the only people he is going to operate on. I am not faulting a surgeon who has only done a couple surgeries for doing another one -- he'll do what he needs to do to be reasonably sure his patient is going to live through it. But as of 2008, three years ago, a local news story on the sleeve said that " only a few surgeons in the country" knew how to do this procedure.

Anyway my suspicion is that your pre-op diet reflects what reassures the surgeon according to certain criteria and what will appease your insurance company. Whether it is specifically *necessary* to do the operation is another thing. It's the only logical conclusion I can come to based on what I've been reading. Why would a person need to lose ten percent of his body weight *before* surgery? It makes no sense -- but it might make sense according to some JAMA study the insurance companies like.

The other thing I've noticed is that while Dr. Aceves' pre-op is not the most rigorous in the world -- his POST-OP is incredibly strict. Why? Because complications don't occur before surgery. They occur afterwards. That's why his patients ( and some others I'm sure) leave the hospital on Clear liquids for ten days, not three. Or more actually. It seems like the majority of post-op complications come from patient noncompliance some time after surgery, like the person who goes to a barbecue three days out and attempts chili. It seems more important that you don't do that than *anything* you do beforehand within reason.

So what it comes down to is this -- at this point this surgery is unique to the surgeon. His experience, whatever pressures there are from the money or the hospital, and his specific expertise in punching you open and refashioning your internal organs. And this is why I say the American system is fuqed. It would all be so much easier if some of those pressures were lessened, and insurance didn't put so many roadblocks in the way -- not just for patients but for the whole procedure.

Thats what I think!

I'm not a person to take risks and all I'm saying is, really; for me, going to Mexico is too risky. And expensive, out of pocket which is not an option for me right now. I'm half Hispanic/native American, I'm afraid they wouldn't let me leave. LOL And I'd get picked on for not speaking spanish. (no, i'm not illegal)

But anyways, I was just stating an opinion. There's so many loops that we have to get thru for the insurance and surgeon and I don't mind them because I know I'll be ready. For example, Kaiser requires a full psych evaluation and group/individual sessions. I like that. Being able to vent to a psych who specializes in bariatric patients and has probably seen it all, is very comforting to me. CUZ I'm scared! I want to do it but I'm so scared about the surgical complications, not being able to stay away from my old eating habits, or gaining it back. There's a whole team I'm accountable to; dieticion, nutritionist, a nurse who calls me periodically to check in, the pshychologist and the surgeon.

I was born with no thyroid so having this team, for me, is what I feel I need. I'm sure it's not everyone's preference. I was dead set against this surgery til a few months ago. Actually, I was set against the gastric bypass but then they told me about the sleeve and I jumped on board. I've watched so many youtube videos of people who have had the courage to do this and they inspired me.

As for the money, I know they all make a mint, here and all over the world.

I was dead set against surgery too. I thought it was self-mutilation. Then I realized I'd been mutilizing myself over this issue for most of my life.

Actually I think the real true reaason for the pre-op diet is because if I wasn't on it I would do what any normal fat or thin person would do if you told them they would not be able to eat for a month and then very very carefully forever thereafter. I would go insane trying to stuff everything in my mouth I would tell myself I would never taste again. If you want to make an obsessive overeater out of anyone, just tell them the world will be all out of food next week...

this was very funny!