I am in the process of debating the pros and cons of two surgeons - Dr. Nicholson in Dallas and Dr. Houston in Nashville. I live just outside of Nashville so it seems like the logical choice would be to go with Dr. Houston. But, since I'm going the self-pay route, I have to factor price in my decision. Here's my pros and cons list thus far:

Nicholson

Pros

Great reputation, including bedside manner

Price $12,200

Pretty much guaranteed I could get in for surgery in December

Cons

Won't get to meet him or have pre-op work done until day before surgery

Have to travel almost 11 hours - kinda worried about that on the ride home

If post-op complications pop up, I am on my own - and insurance may very well not cover any of that care

Only aftercare will be phone calls to his office

Houston

Pros

Great reputation

90 days of post-op complications covered

Office 25 minutes from my house

Plenty of support pre and post op

Cons

Probably $18,800 when all is said and done

Not sure if I could have surgery in December with him. Two reasons - not sure if I will have enough $$$ saved by then and he's out of the office for 2 weeks in December. Will know more after my consult with him.

I'm torn - now that I've made up my mind to have the surgery, I want it done ASAP. December would be great because I teach and my classes end December 11 and don't restart until January, uh, 19th maybe? Plus my husband has off 2 weeks in December and can take care of me.

If I don't have surgery in December, the earliest I could have surgery would be the end of the Spring semester - some time in May. I could save more $$$ but I'm like, man, that's 6 months from December. If I had surgery in December, I could be down some significant poundage in six months.

I think I am leaning toward going with Houston. I think I'm just worried if something goes wrong, for peace of mind and wallet, staying close to home just makes more sense than traveling anywhere. Plus with Houston, I get access to their nutritionist, exercise physiologist, support groups, etc.

I know a lot of folks here have traveled to get the surgery - do you feel like you missed having the aftercare?

Thanks for letting me think this issue "out loud."

Melissa

I'm very new to this and don't have all the answers, but in going to toss my two cents in here and expect that some knowledgable people will come in here with some experience. I'm thinking in particular about your insurance question. Though you're doing self-pay, are you certain your insurance would not cover any medical issues that might arise from potential complications? Using an extreme example here, but if I modified my body by getting a tattoo (not covered by insurance), and that tattoo got infected, I'd treat the infection by seeking medical care. They'd have a whole different set of medical billing codes unrelated to the actual tattoo itself. I'm wondering if your insurance would have the same kind of thing. It might be worth calling the local doc to find out what billing code they would use when billing the treatment of a leak, then calling your insurance to verify that code would be paid.

Additionally, though my doc requires four nutrition appointments before surgery, my insurance only pays for three and I have to pay for the other. Perhaps your insurance pays separately for some nutrition appointments that you could schedule on your own? As for support group, the one my doctor's office feeds into is off the hospital campus and is free to the public. We signed in and listed pre- or post-op, but no one asked ever where surgery happened or where it would happen, so a little networking in your area might open up a group for you nearby.

I'm obviously not telling you what choice to make, but when I was looking at 100% self-pay, I was thinking of some of the very same things.

Hi there, did you ever look into the Georgia docs? Not as far as Houston and much less than $18,000.

Factor in your travel expenses when considering things - my doc has us stay in town for 10 days until the first post-op appointment if we aren't local (we travelled about 6 hours to SF for my VSG, and my wife's DS a few years ago.) The 11 hour drive home should probably be broken up into two days - I had no trouble travelling the six hours when I went home after the 10 days. My doc also has an office about an hour away from home for follow ups and support group meetings, so that helped in the decision to go with him instead of someone local.

I fully understand the desire to get on with it once we make the decision to go the surgical route. Depending upon your history, etc. a decision to wait and go local can be a very good one if you take that extra time to work on improving your habits for the long haul. It is often stated on these boards and in the various programs that success involves major lifestyle and habit changes for life; however most programs say that and then go put you on yet another diet pre-op, post-op and loss phase, leaving most sort of hanging when it comes to actually making these long term changes once they get to maintenance.

What I did in my somewhat circuitous route to my VSG (as my wife was already going thru the WLS process,) was to start making those habit and lifestyle changes when we decided to get serious about our weight problem. This was specifically not any of the fad or book diets that get the weight off in the short term only to experience total regain (or more), but was an effort to make the sustainable long term changes that we all know that we should make (cutting out or minimizing the crap, more fruits and veg, whole grains and lean Protein, more activity/exercise, etc.), and that worked quite well. I lost 50 of the 150 lb that I needed to lose, and most importantly, kept it off for several years until circumstances converged to get me into the VSG. I probably could have lost it all with one of those fad diets, but I would very unlikely have been one of the 5% or so that can keep it off. Was it perfect according to proper nutritional theory and the latest book diets? Of course not, but it was what I could do within my tastes and tolerances, and there were substantial changes that I was able to make within those limits.

Once I decided to finally go for surgery (insurance finally covered the VSG and I concluded that I wasn't going to permanently lose the rest of the weight by the habit changes alone), the process was much easier as the dietary changes for loss, once beyond the initial post-op transition phase, were not such a major change to what I was used to pre-op, or to what I am doing now in maintenance; cheating on the diet was less of an issue as the cheats were fundamentally healthy fare that I was already used to.

The bulk of the changes that I made occurred in the first six months with mostly continuous tweaking after that to improve nutrition and trim calories where I could, but most of the good habits were established fairly early and then reinforced thereafter. so that is a timeframe consistent with your needs if you go for the springtime surgery (and is still worthwhile if you can get a December date.)

Short answer here is that even if you decide to wait until spring to go with the local doc, you can get a good start on your journey now rather than just waiting for some future date.

Good luck on your adventure,

We got sleeved in Mexico. I can't say whether I would have appreciated more aftercare of not, because we went into it knowing our after care would be long-distance. I think getting sleeved away from home does put the burden more on the individual, to self-educate, and to stay on track. In our case, I am extremely curious and would have read up on everything even with a local doctor. I also don't need a surgeon telling me what to do daily. I do need a surgeon who will respond when I need help.

Our doctor emails responses, the coordinator is available and if I have further questions, I come here.

If you want pre-classes, routine follow-ups with the surgeon (our PCP will be doing the follow-ups) then local may make sense. Otherwise, find the best surgeon at the best price and go for it. My POV

Hey gamgirl...Im headed to Mexico. I hate the insurance and nutrition classes for US docs bc seriously, if it would work I wouldnt be a lifelong regain queen. I stick to doc orders very well so Im going to Tijuana.

Hey gamgirl...Im headed to Mexico. I hate the insurance and nutrition classes for US docs bc seriously' date=' if it would work I wouldnt be a lifelong regain queen. I stick to doc orders very well so Im going to Tijuana.[/quote']

I'm the same way! Show me a food and I can tell you how many calories in it! Seriously if calories in and calories out worked, I'd be like Twiggy.