A Crossroads:The Sleeve or Roux and Y???
Both Kaiser NorCal and SoCal like to pretend the DS doesn't exist. Yet I believe without exception (not counting the one case we are still helping a patient appeal) EVERY SINGLE PERSON WHO HAS WANTED THE DS SINCE 2004, AND WHO HAS BEEN HELPED BY ME AND LARRA TO APPEAL TO THE DMHC, HAS WON THEIR APPEALS.
What has happened after that has changed over time:
NorCal Kaiser generally would have to pay "retail" prices to one of the local DS surgeons, usually Dr. John Rabkin at Pacific Laparoscopy (www.paclap.com), one of, if not THE, premiere DS surgeons in the world, to do the DS on their patients who are fortunate enough to discover the DS and recognize its superior results, who have the resolve to appeal (often with the help of Larra and/or me) to the DMHC - the external medical reviews the DMHC uses, CHDR/Maximus, which has almost without exception approved the DS and forced Kaiser to pay for it. Now, NorCal Kaiser has a contract with Dr. Rabkin, and they send patients exclusively (as far as I know) to Dr. Rabkin when they lose the DMHC appeals, and in fact (and this is almost priceless) - they have started sending some of their fattest and sickest and oldest patients DIRECTLY to Dr. Rabkin after only one denial - that way, Kaiser's own failure rates (which are of course going to be much higher for these patients if they have lesser surgeries) are "foisted" off on Dr. Rabkin and don't get counted in Kaiser's statistics.
SoCal Kaiser is more complicated. In prior years, when SoCal Kaiser lost the DMHC appeals, the patients would be allowed to see either Keshishian or Crookes (at USC). However, SoCal Kaiser now has its own "DS surgeon" (not anyone we would consider a vetted surgeon by the DSFacts standards) who did a few DSs in the past (I think it was with Anthone when he was still at USC? I don't recall). The last few patients who won their appeals with the DMHC have been forced to use him - Dr. Gary Belzberg at Harbor City Kaiser. These patients have done OK, but he does not have the level of experience *I* would find satisfactory. Recently, we have seen a SoCal Kaiser patient who went directly to Belzberg and got "approved" by him for the DS, but there is now a hangup with this patient trying to overcome the requirement for the USELESS Options classes.
I find it interesting that both Kaisers STILL refuse to teach their bariatric patients that the DS is a viable surgical option, despite the fact that there have been multiple court cases in which the courts held that withholding information about procedures that are options are a form of assault - failure to obtain fully informed consent - because the patients CANNOT give informed consent if they are not FULLY INFORMED. I am trying to get a law firm I know in LA to take on a class action suit against Kaiser - anyone who feels that they have been HARMED by Kaiser's failure to inform them about the DS should send me a PM.
What has happened after that has changed over time:
NorCal Kaiser generally would have to pay "retail" prices to one of the local DS surgeons, usually Dr. John Rabkin at Pacific Laparoscopy (www.paclap.com), one of, if not THE, premiere DS surgeons in the world, to do the DS on their patients who are fortunate enough to discover the DS and recognize its superior results, who have the resolve to appeal (often with the help of Larra and/or me) to the DMHC - the external medical reviews the DMHC uses, CHDR/Maximus, which has almost without exception approved the DS and forced Kaiser to pay for it. Now, NorCal Kaiser has a contract with Dr. Rabkin, and they send patients exclusively (as far as I know) to Dr. Rabkin when they lose the DMHC appeals, and in fact (and this is almost priceless) - they have started sending some of their fattest and sickest and oldest patients DIRECTLY to Dr. Rabkin after only one denial - that way, Kaiser's own failure rates (which are of course going to be much higher for these patients if they have lesser surgeries) are "foisted" off on Dr. Rabkin and don't get counted in Kaiser's statistics.
SoCal Kaiser is more complicated. In prior years, when SoCal Kaiser lost the DMHC appeals, the patients would be allowed to see either Keshishian or Crookes (at USC). However, SoCal Kaiser now has its own "DS surgeon" (not anyone we would consider a vetted surgeon by the DSFacts standards) who did a few DSs in the past (I think it was with Anthone when he was still at USC? I don't recall). The last few patients who won their appeals with the DMHC have been forced to use him - Dr. Gary Belzberg at Harbor City Kaiser. These patients have done OK, but he does not have the level of experience *I* would find satisfactory. Recently, we have seen a SoCal Kaiser patient who went directly to Belzberg and got "approved" by him for the DS, but there is now a hangup with this patient trying to overcome the requirement for the USELESS Options classes.
I find it interesting that both Kaisers STILL refuse to teach their bariatric patients that the DS is a viable surgical option, despite the fact that there have been multiple court cases in which the courts held that withholding information about procedures that are options are a form of assault - failure to obtain fully informed consent - because the patients CANNOT give informed consent if they are not FULLY INFORMED. I am trying to get a law firm I know in LA to take on a class action suit against Kaiser - anyone who feels that they have been HARMED by Kaiser's failure to inform them about the DS should send me a PM.
Elizabeth N. has deleted this message.
I'm a Kaiser patient--So Cal (Woodland Hills facility). They won't tell you about the DS. If you ask they'll tell you lies. They told me blatant lies and contradicted my surgeon. The surgeon approved me for the DS because I walked in there knowing more about the aftercare than HE knew. I knew my **** (pardon my french) and I made it clear that this was the best choice for me. The head bariatric nurse in Woodland Hills said that the DS would kill me. She said DS patients are very sick patients. She was referring to an older procedure called the JIB --but it didn't matter that I told her to research the DS for herself. Kaiser will do everything they can to discourage you and prevent you from getting the DS.
DianaCox is right about the surgeon. Belzberg is not a vetted surgeon and I know he's only done a hand full of DS procedures. I'm not totally comfortable with him doing the surgery--but I know of another DSr who had it done by him and has had NO complications. She doesn't and has never had diarrhea, she doesn't have gas, and she's lost around 90 to 100 pounds in just 8 months. She also eats whatever she wants. She eats carbs when she craves them and finds that they don't bother her. She fills up on her 100 grams of protein a day eating whatever protein source she wants without regard for fat calories. Bacon, ham, beef, those are a staple for her because she likes those foods. Does she eat an inordinate amount of fat, hell no. But she doesn't have to worry when she goes to Starbucks and eats an cake-pop--it doesn't cause her to gain and it doesn't cause her to dump (because she's had the DS) and it doesn't cause her to fart or have "anal leakage" (lol). DSrs have to focus on protein first, fat if they get constipated, and watch the sugary carbs. If you look up a normal diet today, they'll tell you to focus on protein as well and go light on the carbs.
Regarding Belzberg at Kaiser, he does a lot of RNY and VSG. But he's also the go-to guy to put people's intestines back together after cancer, blockages, etc. He knows and understands all about intestinal surgery. Bookfaerie who had the surgery by him once said, "If all you ever do is open freezer doors, when you get to a refrigerator door you don't need instructions to open it. It's the same mechanism." Belzberg deals with intestinal surgery all the time so I'm trusting him. But if I wasn't so damn tired of fighting with Kaiser (because that's what you'll get) I might have petitioned the DMHC (Cal Dept of Managed Health Care) to force Kaiser to pay Crookes or Keshishian to do the surgery. If you want some advice or tips with Kaiser, private message me and I'd love to chat. Where do you live in SO Cal?
Sher-
DianaCox is right about the surgeon. Belzberg is not a vetted surgeon and I know he's only done a hand full of DS procedures. I'm not totally comfortable with him doing the surgery--but I know of another DSr who had it done by him and has had NO complications. She doesn't and has never had diarrhea, she doesn't have gas, and she's lost around 90 to 100 pounds in just 8 months. She also eats whatever she wants. She eats carbs when she craves them and finds that they don't bother her. She fills up on her 100 grams of protein a day eating whatever protein source she wants without regard for fat calories. Bacon, ham, beef, those are a staple for her because she likes those foods. Does she eat an inordinate amount of fat, hell no. But she doesn't have to worry when she goes to Starbucks and eats an cake-pop--it doesn't cause her to gain and it doesn't cause her to dump (because she's had the DS) and it doesn't cause her to fart or have "anal leakage" (lol). DSrs have to focus on protein first, fat if they get constipated, and watch the sugary carbs. If you look up a normal diet today, they'll tell you to focus on protein as well and go light on the carbs.
Regarding Belzberg at Kaiser, he does a lot of RNY and VSG. But he's also the go-to guy to put people's intestines back together after cancer, blockages, etc. He knows and understands all about intestinal surgery. Bookfaerie who had the surgery by him once said, "If all you ever do is open freezer doors, when you get to a refrigerator door you don't need instructions to open it. It's the same mechanism." Belzberg deals with intestinal surgery all the time so I'm trusting him. But if I wasn't so damn tired of fighting with Kaiser (because that's what you'll get) I might have petitioned the DMHC (Cal Dept of Managed Health Care) to force Kaiser to pay Crookes or Keshishian to do the surgery. If you want some advice or tips with Kaiser, private message me and I'd love to chat. Where do you live in SO Cal?
Sher-
Sher--the bear mama
Listen closely to me. While I do not have much personal experience yet with Bariartic surgery I ma married to an RN for 30 years now that does. In addtion my wife has a group of girlfriends that aer all RNs and ahve worked in the ORs. ERs, Recovery Rooms, Med-Surg units, etc for at least 25 years each. Between the six of them they have 150 years of combined experince. Also, all fo them have been promoted to mamagement over the years and two of them teach at the University of Texas School of nursing in Austin, TX.
When I told them that I was consdiering having the lap abnd, or the RNY, or the gastric sleeve, EVERY ONE OF THEM TOLD ME NOT TO GO WITH THE RNY, AVOID IT AT ALL COSTS. That is because the post surgical complication and mortality rate for the RNY is so high compared to ANY other bariatric surgery. In fact, they have each taken care of one or two treminal RNY patients over the years because things had gone bad and they were staving to death. They were only able to 'eat' very expensive lquid, high protien, foods injected through a central line into their stomachs.
This is what they told me and they are all non-nonsense, well experienced nurses with the training and knowledge to back up what they say.
I then decided to try the lap-band or the gastric sleeve. My doctor told me that the long term outcome for lap band is worse than the long term out come for the sleeve. In the end I decided on the gastric sleeve and I am scheduled for surgery on 9-14-2011.
Best of luck to you!
When I told them that I was consdiering having the lap abnd, or the RNY, or the gastric sleeve, EVERY ONE OF THEM TOLD ME NOT TO GO WITH THE RNY, AVOID IT AT ALL COSTS. That is because the post surgical complication and mortality rate for the RNY is so high compared to ANY other bariatric surgery. In fact, they have each taken care of one or two treminal RNY patients over the years because things had gone bad and they were staving to death. They were only able to 'eat' very expensive lquid, high protien, foods injected through a central line into their stomachs.
This is what they told me and they are all non-nonsense, well experienced nurses with the training and knowledge to back up what they say.
I then decided to try the lap-band or the gastric sleeve. My doctor told me that the long term outcome for lap band is worse than the long term out come for the sleeve. In the end I decided on the gastric sleeve and I am scheduled for surgery on 9-14-2011.
Best of luck to you!
"God makes the wind. We set the sails."
Avonlea
on 8/28/11 4:32 pm
on 8/28/11 4:32 pm
I am currently figuring out whether to get the DS or VSG. It would DS except for some iron issues in my family and in my own genetic history that may push me to a VSG. I'm going to be seeing a hematologist to learn more.
You couldn't pay me to have an RNY or LapBand.
With the VSG, I think it's a decent surgery for people who maintain pretty well. I have been in that camp for a long time (I'm fairly new to morbid obesity due to pregnancies), so I am hopeful that if I go with the VSG, it would work. I have a hard time losing weight, but the times I've done it, the weight has stayed off for pretty long periods of time ****il pregnancy). That having been said, if I go with the VSG, I will be putting in routines and checks that are as demanding as managing my vitamins would be with the DS, hopefully to catch weight regain early. And with the VSG, I will still need to supplement. I also refuse to have one of those super-tight string-bean sleeves, so I will have even more to watch if I end up with the DS.
If you can easily lose 100 but you can't keep it off, I'd be pretty worried about having the VSG. I think it can be done, but remember, the sleeve stretches. Re-sleeving (e.g., converting to the DS later) is a very tricky operation. I would not make that my "ace in the hole" by any means.
I don't pay much attention to testimonials from people who are less than three years out. Every surgery has a honeymoon period.
You couldn't pay me to have an RNY or LapBand.
With the VSG, I think it's a decent surgery for people who maintain pretty well. I have been in that camp for a long time (I'm fairly new to morbid obesity due to pregnancies), so I am hopeful that if I go with the VSG, it would work. I have a hard time losing weight, but the times I've done it, the weight has stayed off for pretty long periods of time ****il pregnancy). That having been said, if I go with the VSG, I will be putting in routines and checks that are as demanding as managing my vitamins would be with the DS, hopefully to catch weight regain early. And with the VSG, I will still need to supplement. I also refuse to have one of those super-tight string-bean sleeves, so I will have even more to watch if I end up with the DS.
If you can easily lose 100 but you can't keep it off, I'd be pretty worried about having the VSG. I think it can be done, but remember, the sleeve stretches. Re-sleeving (e.g., converting to the DS later) is a very tricky operation. I would not make that my "ace in the hole" by any means.
I don't pay much attention to testimonials from people who are less than three years out. Every surgery has a honeymoon period.
Avonlea
on 8/28/11 4:45 pm
on 8/28/11 4:45 pm
One additional point: some what has been said in this thread about life with the DS is either untrue or true for a very, very small percentage of DS patients. You need to read about life with the DS on the DS board or dsfacts.com to get a more accurate picture.
I also don't think it's true that VSG patients are on a permanent diet -- I've seen that thrown around a few times as well. I don't think it's accurate to talk about eating celery sticks, for instance. From what I have observed over the years, the VSG diet is a protein-first diet much like the DS, and it does tolerate fat consumption. That having been said, I can say that I think it would be hard to maintain the VSG if you're not a regular exerciser. I don't think it's permanent diet so much as permanent exercise. I think the DS offers a little bit more breathing room as far as exercise goes. For me, I can live with that, because it's only recently that I haven't been a diligent exerciser, but I've otherwise been a pretty rigorous exerciser for most of my life. I would examine your own patterns fairly closely, though.
I also don't think it's true that VSG patients are on a permanent diet -- I've seen that thrown around a few times as well. I don't think it's accurate to talk about eating celery sticks, for instance. From what I have observed over the years, the VSG diet is a protein-first diet much like the DS, and it does tolerate fat consumption. That having been said, I can say that I think it would be hard to maintain the VSG if you're not a regular exerciser. I don't think it's permanent diet so much as permanent exercise. I think the DS offers a little bit more breathing room as far as exercise goes. For me, I can live with that, because it's only recently that I haven't been a diligent exerciser, but I've otherwise been a pretty rigorous exerciser for most of my life. I would examine your own patterns fairly closely, though.
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