Free Press article

An article about the sleeve I had appeared in the Free Press:

http://www.freep.com/article/20090817/BUSINESS06/908170320/Surgery+offers+bigger+weight-loss+payoff

Also has other findings from BCBS studies.

www.freep.com/article/20090817/BUSINESS06/908170320/Surgery+ offers+bigger+weight-loss+payoff

yep wow

I saw this---very informative!  Gave me sleeve envy :)

I have my RNY on Wednesday in Lansing!

I am happy whenever I see articles that show how bariatric surgery has improved the life of someone, as it really helps to chip away at the sterotype of  "the easy way out".

I was sadly disappointed in this article, however.  Here are the reasons:

There is absolutely no mention of the most effective WLS available:  the DS!!
None of the surgeons (or those keeping this "data base" for that matter) offer the DS, and are not qualified to do so.  It is a terrible injustice to those considering WLS that this option was not brought to their attention.  The DS has been around for at least 21 years, there is data on patients from 11-16 years out just being published and the results (healthwise and continued percentage of EWL) continue to be far superior to any other WLS available, and it is the only surgery that is an actual cure (99%) for type II diabetes (others put the type II diabetes in remission -- the DS cures it, as seen in the many other countries performing just the intestinal or switch portion of the DS on normal weight individuals as a cure to type II diabetes).

The continued reference to the gastric bypass being "minimally invasive" is perplexing.

There are newer studies coming out on the VSG, and at 4 years out the data takes a sharp turn and is disappointing.  This data is from the studies done by Cringle & Jossart in Cali, two of the most proficient sleeve providers and certainly the largest group of patients to study.  And NO I am not basing anybody's choice of surgery, simply stating the facts.  Strong proponents of the VSG counter the disappointing data with the argument that the sleeves of those 3-4 years out are larger and thus they can consume more, however, leading bariatric research surgeons do not believe this is a solid argument as the results mirror findings in other restriction only procedures.

The sleeving of the stomach is a fairly easy procedure, so of course any surgeon who can perform a RnY is jumping on the opportunity to offer the VSG.  It is the switch portion of the DS that requires a highly skilled surgeon, one who has taken time away from a busy & profitable bariatrics practice to proctor under another DS surgeon.  The DS takes more time in the OR than any other procedure, thus less patients one can churn out during the day, thus less income for the surgeon.  The complication rate of the DS (on the table, shortly after surgery, and long-term) remains neck & neck with the RnY.  Many surgeons who don't perform the DS provide potential patients with inaccurate information about the DS, in attempts to dissuade someone from seeking an option they themselves do not perform.  These same surgical offices often tell people that the DS would not be covered --- yet is it.  It is not experimental, it is covered by Medicare for longer than 4 years now!!

Sloppy journalism, at its best.


For those interested, BCBS is making many changes.  Each state franchise is different, but from a national policy perspective, BCBS is now going to cover the DS for those with a BMI of greater than 50.  There is a ground swell within the DS community to also cover the DS for those with a BMI under 50.  Basically, anyone who qualifies for WLS (which is now usually reserved for just the Gastric Banding & RnY), should be provided with the option for the DS & VSG.

OK, at risk for starting a debate about surgeries (which I am not trying to do!), you clearly stated why more surgeons aren't offering the DS - It is the switch portion of the DS that requires a highly skilled surgeon, one who has taken time away from a busy & profitable bariatrics practice to proctor under another DS surgeon.  The DS takes more time in the OR than any other procedure, thus less patients one can churn out during the day, thus less income for the surgeon.  The complication rate of the DS (on the table, shortly after surgery, and long-term) remains neck & neck with the RnY.

Being the surgeon, why WOULD you take time away to learn a new procedure, that takes more time in the OR, thus making it less profitable, when the complication rates are the same as an EASIER surgery to perform?   That right there explains why it's not an option most of the time, I think.  Not saying it's not a good surgery or that someone shouldn't have it, but I don't think it will be as "mainstream" as some of the others because of these reasons....good, bad or indifferent.  I'm all for a person having the surgery that is RIGHT for them, regardless of what type of surgery they have. 

I saw the article while standing in line at the gas station and only read what was on the first page.  Was glad to see a positive article about WLS, though.  

Tina, I didn't see that part in the article...what page was it on?

I think it's hilarious that Dr. Birkmeyer, who is running the Bariatric registery, was my surgeon and could absolutely care less about me or my surgery outcome now that I'm 3 years out.  To me, it's all hype.

The part I copy and pasted was from Kim's reply. 

That's sad that your surgeon, from somewhere so reputable, is like that!

No debate here.  I appreciate any open discussion on the topic!

I have no issues with surgeons who don't perform a more challenging procedure, my issue with the majority of these surgeons is that they actually lie to the patients about the DS, if they mention it at all.  Those that provide inaccurate information, are of course just unethical (or not up-to-date on medical research as I would expect from anyone cutting in to me), and I wouldn't trust one of them with cutting my dog's toenails.  Those that don't mention it, or have the attitude that what they can provide is "good enough", I also find boarding on unethical, because they are not providing a patient with a full picture of their available options.

I am not of the mindset that the DS is for everyone.  On the contrary, the DS is the biggest commitment to not only knowing your new anatomy (because the majority of medical care providers will know nothing about it and most assume you have no idea what you are talking about and really have a gastric bypass)  -and-  the biggest commitment to blood work and supplementation (all WLS patients should follow the same routine for blood work --- every 6 months and supplement as directed by the lab results --- but the DS can kill you or do considerably more damage a whole lot faster if a patient is not compliant) --- so I actually think that there should be more effort into screening DS patients than there is now.

There are just too many, far too many, people going in to get a WLS with no knowledge of all of their options --- options that very well may have been better for their particular situation,  -or-  being lied to.  I know, I know, doctors don't lie.  Bwhahahaha!  And, that really is the point --- they should be doing what is in the best interest of the patient.  They take that oath.

Provide the accurate information.  We wouldn't expect anything less than that for any other disease.  If a patient presents with cancer, they are sent to an oncology specialist.  If that oncology doctor doesn't have the skill set or equipment or whatever to provide the patient with the treatment option best suited for that patient, they should be referred to someone who can.

I also can't stand the attitude of so many bariatric surgeons, which to me screams fatty hater --- well, you should be happy because you are better off with what I could do for you than you would have been without it.  The 50% EWL as a "success rate" is pure BS.  We deserve better, and we should expect more from our health care providers.

Changes in the insurance coverage will bring the DS more mainstream.  There are only 6 states now that a patient can't fight their insurance companies and get a DS if they were approved for a RnY (and that is because these states don't allow for an external review process, i.e. the insurance companies always win).  Insurance companies have come a really long way in covering the DS since Medicare started covering it --- they realize it is a no win situation fighting the patient appeals, they always lose (in all the states except those 6).  Many now see the financial advantage of the DS and the resolution of co-morbs long-term.... so, we are seeing more & more surgeons offering the DS.  At the same time, we are seeing a huge upsurge in the number of doctors (not necessarily classically trained surgeons) offering the Gastric Banding because of the ease of installation & profit margin of maintenance.... the skilled surgeons who had previously refused to install a GB are doing so now, bowing to the economic pressure.  It is sad.

I know that WLS is a business, as is all medicine really.  I am not that naive, even though I am still saddened by it.  Anyone who doesn't realize that there are financial reasons as to why they are not provided with the full spectrum of their WLS options, or provided with inaccurate information about their options, is sadly naive.  I find it to be dangerous to accept this.  This isn't a credit card or used car with buyer beware, we trust these people to have our best interests in mind when recommending our options.  We are vulnerable, and taking advantage of people when it can actually mean their life is deplorable.


Edit:  spelling.    And, OMG, sorry so long!   Can you tell that I am pretty passionate about this subject?!?

Always important for me to remember that facts don't lie, but they can be misconstrued and interpreted to make any point. How much weight was gained and by how many people? I always wonder when those longer studies find that there is weight gain four plus years out, why? I was told by  people before my surgery, "Oh, I know a person that had the (lap band, RNY, sleeve) and now they have gained all of the weight back." Well, did the person exercise? Follow a good eating plan? Work with support groups and his/her physician? The sleeve, for me, was the best option. It may not be for everyone. And considering that the article was about the sleeve (mainly), I just thought it was a good look at the possibilites. I am hopeful for all who need it to be granted a chance at better health and vitality.

If I ever need a revision, I am going sleeve all the way!