Newbie with lots of Q's

Without going through the long drawn out story of my life long weight struggle, I'm at the end of my rope and finally decided it was time for WLS. I've done a lot of research, especially on this forum, but my head is spinning and I was hoping to get some valuable insight here.

So here goes. My insurance is ridiculous and requires 12 months of medically supervised dieting. I've been on every diet known to man and don't want to waste another year dieting. I am 48 and am ready to get healthy and lead an active life with my kids. Fortunately I recently inherited enough money to cover the cost of WLS. So I will probably go the self pay route.

Researching the various options, I firmly believe BPD-DS is the best option for me. I live in Charlotte and the only local dr. providing this surgery is not very well regarded from what I can tell (Dr Voellinger). I have not made an appointment with him after the reviews scared me off. I have been to another local dr that only performs RNY (and VSG). I was ready to proceed with the RNY as better than nothing, but I don't want to have a major surgery and then need something else down the line.

Question #1, how to choose a DS doctor if I'm going to have to do some travel? I have read rave reviews for Dr. Esquerra at Mexicali Bariatrics and he seems both extremely experienced and cheaper than US doctors. But are there closer DS doctors people recommend in the south or east coast of the US that I should at least look into?

Question #2, self paying certainly makes getting the WLS quicker and easier. But does this mean that any complication such as a bowel obstruction down the line will not be covered by insurance? Even if I switch to a different insurance company in the future? In other words, is the mere fact that the original surgery wasn't covered by any insurance mean that for the rest of my life, anything that can be considered caused by the surgery won't be covered? I have some money but not enough to cover something catastrophic like a month in the IU.

Question #3, does self pay and/or using a non-local doctor make it too challenging to get the required labwork for the rest of my life? It seems like most people use their PCP and not their bariatric surgery center for their labwork, at least after the first year?

Question #4, how do you go about finding a PCP with some knowledge about the labwork required, or at least willingness to order the bloodwork you tell them you need? Does anyone have a PCP they would recommend in Charlotte?

Question #5, the gastric bypass doctor I saw recommended I get an upper endoscopy. For the past few weeks I have had lots of heartburn. I don't normally, but I finally gave up on my vegan diet and have just been eating whatever for the past few weeks. I've gained 10 pounds in 3 weeks and probably things like cheese and carbs are contributors to the heartburn as well as perhaps the extra weight. Is it recommended to get an upper endoscopy before any WLS or just gastric bypass? Has anyone had the DS surgery without getting an upper endoscopy? My issue is that if I decided to go to Dr. Esquerra he could probably do my WLS before I can even get an upper endoscopy (my initial consultation with the gastroenterologist I was referred to isn't for over 3 weeks, and then who knows how long it would take until I actually could get an endoscopy scheduled). I know it's jumping into things but I am SO ready and I have a golden opportunity this summer with my ex taking my kids on a 10 day vacation, thus I'd be able to go away to get WLS.

Thanks so much for anyone taking the time to read this and for anyone that has any advice for me.

Generally speaking the DS is NOT for vegans. Your diet postop is high protein, high fat, and low carb.

Assuming you are OK with the postop diet, if I was in your place, I would go to Esquerra and just get it done. You will be much better off with him than the other doc you mentioned. Alma Mater Hospital is good too.

Most of those tests are done because it covers the docs hind end if anything goes wrong. Get the list of what you have to do for Esquerra and do just that. No need to do extra stuff. And also some tests have a time to live and they will make you repeat them if you had it done too long ago.

It's not likely you will find a PCP who knows. You have to find one who is willing to learn. You have to be able to advocate for yourself. You can get a list of labs and supplements and start from there.

How old are your kids? 10 days is not long enough to count yourself as recovered from surgery. And you will have serious lifting restrictions for weeks postop. If your kids are old enough to help take care of you it's all good!

People have traveled all over for surgery. Mine was in the US but my sister and H had theirs done in Spain. And there was never any problem with insurance postop for them.

I waited 2 YEARS for a surgery date and it was one of the worst mistakes of my life. With 20/20 hindsight I should have just self paid and done it ASAP. BTW, before surgery I was required to have basic bloodwork and an EKG. That's it.

Congratulation on picking the WLS with the best results. Period! There is nothing better out there.

Thanks for your advice! No I am not normally vegan, that was my latest attempt to lose weight ha ha.

My kids are teeens and teenagers so past the stage of needing to be picked up etc. They can definitely help out around the house and do stuff for themselves. It's more that I can't leave them alone for a week and my ex would not be cooperative if I asked him to take time off work

Yes I guess it's time to stop fooling around and just contact Mexicali Bariatric to find out their requirements Exciting but scary!

I've heard Dr. Greenbaum in NJ has a decent cash price as well and is well regarded.

Thanks, that's a name I haven't seen before, but I've been focused on NC (and Mexico).

Dr. Greenbaum is excellent, but only does the DS open. However, you might also look into Dr. Sudan at Duke - not quite local, but much more local than what a lot of other people have. I don't know what he charges for self-pay or what tests he would require.

I am inclined to agree with Patty that, since you have researched your options and are emotionally ready for surgery, Dr. Esquerra is probablly the way to go. And no, not everyone needs an upper endoscopy. I didn't have one pre-op. Just labs, chest x-ray, and EKG, and that was here in the USA. But if I had other medical problems, or if I had been a smoker, there would have been more tests required.

Larra

Thanks for the info. I guess I will contact Mexicali Bariatric and see what tests etc they need done ahead of time.

congrats on your decision. I believe Dr Keshishian has a good self pay amount, I would at least find out he can give you an over the phone consult that he doesn't charge for and he is excellent in returning phone calls. He has no other fees for out of town patients either. He is one of the top 3 DS surgeons in the world, some would say the best (that would be me also). He is in Glendale, CA https://www.dssurgery.com/ if not my next would be Dr. Esquerra and he is the only one I would see in MX.

no one will be able to answer your insurance specific questions, since your policy is unique to your employer and what they have picked.

using any dr for post DS is challenging since the DS is performed less than 1% of all bariatric procedures that is a LOT of ignorance about it. try to find someone that you can work with, and you have to go in knowing what you need to order and what you need to take for supplements, you cant rely on a PCP---or you'll die a slow and painful deal of malnutrition

I know very well about when you make a decision you want it now, that is human nature. and you don't have to worry about the kids even better.

wishing you health!

Thank you! I have read about Dr. Keshishian and thought I saw that he requires patients to stay nearby for a few weeks after surgery. Unfortunately I can't do that because of my kids.

No matter where you go, it's going to be a tight schedule without a lot of wiggle room. I would urge you to have a contingency plan in place. What if your flight is cancelled or you have some kind of a problem that delays your departure? What if your doc gets sick and has to delay your surgery?

Any good surgeon will require you stay in the area for a few days. It's for your protection. If there is a problem, you have access to your surgeon. If you are going to have a complication, odds are it will be in the first few days.

I am not trying to discourage you. I would be on that plane too. You are worth fixing. You want to be around to see your kids grow up. And you want a chance at a normal life.

I am guessing your plan is to do this while the kids are out of school for the summer? Do you have another friend or relative who could keep them for a few days if necessary?