TEMPE SUPPORT GROUP
It is interesting how you sidestep much of what I said, or make strawman arguments – not addressing the points I made, but rather answering a question different from the one I raised but which you prefer to discuss. You don’t even deny getting kickbacks, but change the conversation to whether DSers have staples – WTF?
Voluntary follow up for DSers is different from necessary follow up with bandsters to get adjustments. Your band patients HAVE to return to your office for repeated adjustments to their fills. I suspect your DSers just gave up coming for follow up appointments with you for some other reason having to do with your practice. I don’t believe PacLap has this problem to nearly the extent you experienced it, because they have a dedicated support system, including Rabkin (who attends MANY support group meetings himself every month, flying all over the west coast, as well as to Chicago and TX to do so), his staff and a loyal and committed patient support system. Why did this not happen in YOUR practice?
I’m not going to get into a battle of wits with you over your practice – I am interested in promoting FACTUAL information about the DS to pre-ops before they select which surgery they have, not specifically in beating down the lap band – there are plenty of others here who have personal experience with the band and who are fully able to make their own arguments against it. I personally think the lap band is a CRAP band, that restrictive-only surgeries in general are doomed to fail for a significant percentage if not a majority of morbidly obese patients, and that the VSG is a superior surgery to the CRAP band if one insists on a restrictive-only procedure (though I think it too is doomed to fail for most patients in the long run – but at least it can be easily revised to a DS).
My specific problem with YOU is your turnaround from your former DS practice to this, and the disinformation on your website.
I also think your statement that all of the surgeries work the same basic way is an out-and-out lie. Restrictive-only procedures work through caloric restriction – period. They are enforced diets, and they fail for the same reason that ALL diets fail – AND they will leave the patients worse off than they were before surgery when they do fail. The DS fixes the metabolic issues at the root of obesity, by correcting the metabolic damage caused by genetics and yo-yo dieting. And the 10 year stats that demonstrate 94% of DS patients are successful (having lost and maintained a loss of at least 50% of their excess weight – the standard used by most bariatric surgeons) is one that the lapband does not even remotely come close to. Your statement “outcomes (weight loss over three years or more) are equal -morbidity and mortality is less- and patient satisfaction is higher with the band than with DS." is simply laughably ridiculous. There is NO published study that I know of showing that weight loss over 3 years is equal between the lap band and the DS – that is PREPOSTEROUS. And I doubt you can prove the patient satisfaction statement either – certainly there are quite a few unsatisfied lap band customers/victims on this very thread.
As I said, I am most dismayed and personally disappointed in YOU. I met you in 2003, and you were a dedicated DS surgeon then. You even said if you needed bariatric surgery, you would have the DS. Now, it appears to me that you have sold out to the lap band franchise, performing an initially less risky but less effective surgery that requires less of your resources as a surgeon, and which likely provides you with a higher income. I thought you were one of the good guys – but I was wrong.
on 11/17/09 12:08 am - Tuvalu
Then you cite a single paper - but not the multiple papers that are out there -- and use that as the sole basis for an argument- a paper that comes from a single source? Yet the whole of papers out there show that the lap-band is safer by a factor of ten- in all aspects?
Then you say I am likely getting kickbacks-- for which you accuse me of, but have no basis for? And yet you fail to note or discuss the many staples that are used are also "medical devices" and something for which device companies are paid. So if Ethicon or Covidian take a DS surgeon to dinner that is not bad, but if they take me to dinner that is bad? Did you know that the staple manufacturers get more for a DS than they do when they sell a band? But because you think one is better it is ok - and not ther other?
Then you say an office visit is less renumerative for one than the other-- although they are coded out the same? So if patients use office visits to learn, to change lifestyle, to have good results because it takes time to learn about any procedure and what it does-- if they do it for one that is ok, but not the other?
Then when a procedure fails - and someone revises it to another - you say that is wrong- but you refuse or simply ignore other data? It is ok to revise from one procedure to another as long as you think it is good?
Thank you for the assumption that surgeons do one procedure for money and the other for love - when you don't know reimbursement rates, motives- but because you like the procedure you had it must be good.
Your arguments are not based on the whole of the data - and your conclusions are based on a flawed belief that if data/surgeons do not believe in your belief they are wrong.
This is not religion- this is medicine- this is surgey.
If you think it is better to reoperate on someone for multiple hernias from the malnutrition of a DS, or bowel obstructions, or leaks than it is to operate on someone to reposition the band- or to take a band out -- you are simply wrong. You can be an evangelist for a procedure- but if you want to cite a small bit of literature and dismiss those of us who take the entire body of literature- admit it.
Here are the facts:
In all large studies across all literature-- the band is safer than other procedures.
The band does require education - as all procedures do- it does requre follow up visits-- as all procedures do-- and the band is adjustable - others are not without major intervention.
There is no trading malabsorption for obesity with the band.
Bad things can happen with any surgical procedure- and if you think a website is what I would use for informed consent then you are so wrong.
Glad you like your procedure- but to say it is better than a lap band is like saying a horse is better than a car because you don't need gasoline.
The band is not flawed, anymore than any weight loss operations are flawed. Patients have a problem of obesity- and this is the tool I seek to use. In our data-- outcomes (weight loss over three years or more) are equal -morbidity and mortality is less- and patient satisfaction is higher with the band than with DS.
"It is interesting how you accuse me of not supplying patient follow up on one hand and then accuse me of seeing patients too much for the band in another- a logical fallacy. If a patient comes in for a post operative visit - whether it be for a DS or a lap band - you consider it business if we charge for one but not the other? "
You know damned good and well what she means and it is NOT what you just asserted. DS patients with SUCCESSFUL surgeons are usually seen a week post-op, then a month post-op, then at three months, six months and a year...and then annually. Many of those SUCCESSFUL DS surgeons include the first year or two of follow-up in the price of the surgery. Ergo, I am four years post-op and have paid for ONE office visit and am about to pay for the second. How many office visits does your average band patient get charged for in four years?
You say you charge the same for a DS follow-up and a band follow-up? Really? My DS surgeon doesn't use barium swallows and fluoroscopy at my follow-up appointments, so there is no charge for those things. Do you just provide "blind adjustments?" Or are patients sent to some other location...and who profits from that? My band doctors charged the usual office visit fee...but there was also a facility fee for the radiology and a provider fee for the radiology services. You don't charge for those? How philanthropic.
You claim that "the lap-band is safer by a factor of ten- in all aspects?" No, not in ALL aspects. In fact, not in the ONE aspect that is going to make a difference to your patients...weight loss sufficient to resolve the morbid obesity that is killing them. A lot like buying a car...with great lumbar support in the seats and a super sound system...but that won't GO anywhere. That car and the band should both be covered under Lemon Laws.
You SHOULD know what a mess the band causes. I have an almost five-year old e-mail here from Heimpens...who thought I was joking when I asked if he had experience revising from the band to other procedures. He replied that fully 20% of his OR time--one day a week out of five--was spent removing LapBands. Surely by now the word would have made its way across the Atlantic.
And, before your fan base gets involved...I DO have business on the AZ board. Mom was born in Florence, Granddad in Casa Grande and there are still cousins there and lots of cousins in Mesa and Tempe. I have to view here once in a while so that I can tell them what kinds of lies they are being fed. It's a shame that there is so much to report.
Sue
http://www.ncbi.nlm.nih.gov/pubmed/18823860?ordinalpos=1&ito ol=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_S ingleItemSupl.Pubmed_Discovery_RA&linkpos=1&log$=relatedrevi ews&logdbfrom=pubmed
Am J Med. 2008 Oct;121(10):885-93.
Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures.
Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD.
Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-1732, USA. [email protected]
Comment in:
OBJECTIVE: Bariatric surgical procedures have increased exponentially in the United States. Laparoscopic adjustable gastric banding is now promoted as a safer, potentially reversible and effective alternative to Roux-en-Y gastric bypass, the current standard of care. This study evaluated the balance of patient-oriented clinical outcomes for laparoscopic adjustable gastric banding and Roux-en-Y gastric bypass.
METHODS: The MEDLINE database (1966 to January 2007), Cochrane clinical trials database, Cochrane reviews database, and Database of Abstracts of Reviews of Effects were searched using the key terms gastroplasty, gastric bypass, laparoscopy, Swedish band, and gastric banding. Studies with at least 1 year of follow-up that directly compared laparoscopic adjustable gastric banding with Roux-en-Y gastric bypass were included. Resolution of obesity-related comorbidities, percentage of excess body weight loss, quality of life, perioperative complications, and long-term adverse events were the abstracted outcomes.
RESULTS: The search identified 14 comparative studies (1 randomized trial). Few studies reported outcomes beyond 1 year. Excess body weight loss at 1 year was consistently greater for Roux-en-Y gastric bypass than laparoscopic adjustable gastric banding (median difference, 26%; range, 19%-34%; P < .001). Resolution of comorbidities was greater after Roux-en-Y gastric bypass. In the highest-quality study, excess body weight loss was 76% with Roux-en-Y gastric bypass versus 48% with laparoscopic adjustable gastric banding, and diabetes resolved in 78% versus 50% of cases, respectively. Both operating room time and length of hospitalization were shorter for those undergoing laparoscopic adjustable gastric banding. Adverse events were inconsistently reported. Operative mortality was less than 0.5% for both procedures. Perioperative complications were more common with Roux-en-Y gastric bypass (9% vs 5%), whereas long-term reoperation rates were lower after Roux-en-Y gastric bypass (16% vs 24%). Patient satisfaction favored Roux-en-Y gastric bypass (P=.006).
CONCLUSION: Weight loss outcomes strongly favored Roux-en-Y gastric bypass over laparoscopic adjustable gastric banding. Patients treated with laparoscopic adjustable gastric banding had lower short-term morbidity than those treated with Roux-en-Y gastric bypass, but reoperation rates were higher among patients *****ceived laparoscopic adjustable gastric banding. Gastric bypass should remain the primary bariatric procedure used to treat obesity in the United States.
Then you cite a single paper - but not the multiple papers that are out there -- and use that as the sole basis for an argument- a paper that comes from a single source? Yet the whole of papers out there show that the lap-band is safer by a factor of ten- in all aspects?
Then you say I am likely getting kickbacks-- for which you accuse me of, but have no basis for? And yet you fail to note or discuss the many staples that are used are also "medical devices" and something for which device companies are paid. So if Ethicon or Covidian take a DS surgeon to dinner that is not bad, but if they take me to dinner that is bad? Did you know that the staple manufacturers get more for a DS than they do when they sell a band? But because you think one is better it is ok - and not ther other?
Then you say an office visit is less renumerative for one than the other-- although they are coded out the same? So if patients use office visits to learn, to change lifestyle, to have good results because it takes time to learn about any procedure and what it does-- if they do it for one that is ok, but not the other?
Then when a procedure fails - and someone revises it to another - you say that is wrong- but you refuse or simply ignore other data? It is ok to revise from one procedure to another as long as you think it is good?
Thank you for the assumption that surgeons do one procedure for money and the other for love - when you don't know reimbursement rates, motives- but because you like the procedure you had it must be good.
Your arguments are not based on the whole of the data - and your conclusions are based on a flawed belief that if data/surgeons do not believe in your belief they are wrong.
This is not religion- this is medicine- this is surgey.
If you think it is better to reoperate on someone for multiple hernias from the malnutrition of a DS, or bowel obstructions, or leaks than it is to operate on someone to reposition the band- or to take a band out -- you are simply wrong. You can be an evangelist for a procedure- but if you want to cite a small bit of literature and dismiss those of us who take the entire body of literature- admit it.
Here are the facts:
In all large studies across all literature-- the band is safer than other procedures.
The band does require education - as all procedures do- it does requre follow up visits-- as all procedures do-- and the band is adjustable - others are not without major intervention.
There is no trading malabsorption for obesity with the band.
Bad things can happen with any surgical procedure- and if you think a website is what I would use for informed consent then you are so wrong.
Glad you like your procedure- but to say it is better than a lap band is like saying a horse is better than a car because you don't need gasoline.
The band is not flawed, anymore than any weight loss operations are flawed. Patients have a problem of obesity- and this is the tool I seek to use. In our data-- outcomes (weight loss over three years or more) are equal -morbidity and mortality is less- and patient satisfaction is higher with the band than with DS.
Can you explain what you mean about multiple hernias ... are you saying the DS causes malnutrition and then that causes multiple hernias?
What do you like? Dislike? about groups you go to... What would you like to do? See? Talk about?
I'd like to offer a daytime meeting like at 9:00 am - what would interest in that be?
We are a LAP-BAND Center so the focus would be on LAP-BAND issues and lifestyle but really? for long terms success I eat the way band patients eat to keep the weight off and being a 9 yr post RNY patient I can offer a lot of support there too....
Id love to hear from you!!!
Let us know when you peg down a day and time. I'll be there and will bring my peeps with me! LOL! I"m not a lapbander, but like you......I realize that learning to make good choices into an ongoing lifestyle will keep me at goal and healthy! As Dr. Simpson reminds us, we can all be in the same place in 5 years, regardless of our choice of surgeries. I'd rather be looking like you any day (My Clairol bottle says "blonde" on it though! LOL!) ...than the gal I used to be.
Hugggzzzz! See you soon!
Joyce Rny 2/11/03-> ERny 12/26/07-> Duodenal Switch 5/12/2010
www.dsfacts.com , www.dssurgery.com , & www.duodenalswitch.com
DARCIE LEIGH EDELKRAUT
LAP RNY 12/2000 -- Pre-Op: 314 lbs BMI 44
Current: 125 lbs BMI 19
www.tempenewday.com LAP-BAND Program Specialist
Darcie, you have seen hundreds if not thousands of lap band patients- what has been your experience with complication rates of bands and how patients use them?
Darcie, you have seen hundreds if not thousands of lap band patients- what has been your experience with complication rates of bands and how patients use them?
Oh com'on Dr. Simpson, of course YOUR re-op rate is low, you only do bands last I saw. You posted this on the DS board a long time ago.
When someone needs a revision to sleeve, bypass, or DS they have to go elsewhere so obviously YOUR re-op rates are going to be low.
I think you are a very good surgeon. I was not thrilled with your office staff otherwise I likely would have gone to you for my own banding but I do know you are a very skilled surgeon. I wish you did revisions, we seriously need a good revision surgeon in AZ. I think your website is deceptive but that does not mean you are not a very skilled and safe surgeon.
I revise to the band - sleeves to band, DS to band, RNY to band.
Before somene needs a revision- I hope they talk to me
I see and do every fill on my patients -
so yes- I think we have good follow up
I revise to the band - sleeves to band, DS to band, RNY to band.
Before somene needs a revision- I hope they talk to me
I see and do every fill on my patients -
so yes- I think we have good follow up
I never suggested your follow up is not good. No idea what you are talking about.
You outline exactly why there is no one surgery type that works for everyone. WLS is like buying a pair of really cool shoes. You can eye them, you can imagine what they will feel like when you put them on but you really don't know if it is a right fit until you try them on, just like cool new shoes. Sometimes the best looking shoes give you mega blisters. ;o) Sometimes the WLS type we choose sucks big time.
I would never do well with DS... too much protein. A high fat diet... not my thing anymore. My band was a horror, I hated every single day of banding. Sleeves, just right.
No, I do not like your website. You list many complications of other surgery types but in your list of comparisons you do not list band issues. Erosions, slips, stoma spasms, pouch/esophageal dilation, etc. Your website is indeed deceptive and I really don't get it. You are a good surgeon able to do all surgery types well. Since WLS is not a one size fits all, what's up with that?
Yes, I was extremely disappointed in your office staff. I have no idea what they are like today, but 12/06 I was totally unimpressed. That is why I went to Mexico. My ins would cover WLS but I did not want to play ins games and jump through hoops. I had the money to self pay and I almost went to you. It was 100% your office staff that I changed my mind. I love and adore my surgeon and trust him completely. I'm glad I went to him because I was not cut out for a band and there was no way to tell this pre op. When I needed a revision surgeon I went back to my surgeon. He's great and I trust him. He did a fantastic job for me. Had I gone to you I would not have tolerated the band and I'd be looking for a seriously good revision surgeon since you only do bands.
I have been reading WLS boards for 3 years. Tons and tons of banded folks looking for revisions. Either they plain old need malabsorption or they can't stand the band anymore than I can. Not to mention the port that sticks out like a tumor after hitting goal and that was with a low profile port.
I do not care for Dr. Pleatman but he makes an interesting comment here:
www.lapbandtalk.com/1189828-post18.html
While I laugh each time he gets his digs in for MX surgeons the amusing part is that US patients are educated about WLS types in the US. US seminars yet they have never heard of sleeves.
Kim Gyurina, OH Staff · 0 replies · 370 views
