My experience with Dr. Almanza

Eme 2009
on 1/20/10 9:42 pm, edited 1/20/10 11:19 pm - FL
I posted this on my blog a few days ago but thought everyone might like access to read it---it's VERY long but details my time from start to finish in Tijuana where I had VSG surgery with Dr. Mario Almanza Reyes.

Pre-Op
I was on a 3 day liquid diet before surgery.  No red dye but I could have jello, broth, juice and a piece of chicken with a small salad in the evening except the night before surgery.  On the day before surgery, I only had broth, jello and Crystal Light lemonade.  
Day before surgery
We flew from Pensacola, FL to Atlanta, GA and then on to San Diego, CA.  Traveling was okay except I was so nervous and anxious.  The flight from Atlanta to San Diego was LONG---3 hours in a middle seat :)  We arrived in San Diego around 8pm and stayed at the Days Inn Harbor View.  It cost about $88 for the night and as we were grateful for the  complimentary airport shuttle, it was not a glamorous hotel and we didn't end up staying there on our way back home.
Surgery Day!!
We took the hotel shuttle back to the airport to meet the Jerusalem Clinic transportation van at the Jet Blue terminal.  I felt like I was meeting up with my roommates on "The Real World".  Haha.  Little did I know that most of the people sitting around the former Lindbergh statue were just on their break from work :)  There was one lady there waiting for the Clinic--Lynne and she was scheduled for surgery that day also--LapBand.  I called the Clinic and the SUV was there momentarily at 7am.  We proceeded to Tijuana.  (As a side note, you do not need identification to get IN to Mexico.  My husband and I took our passports out expecting a check but we just cruised on through the border agents at about 20mph.)

We went immediately to a lab to have blood drawn to check our clotting levels and blood types.  (I am not sure what other information they garner from these tests).  We were there by 7:25am and the lab opened at 7:30am.  Blood work was done quickly and easily and we were on to the Jerusalem Clinic.  

I didn't really know what to expect because I knew that a new clinic had just opened so a lot of the accounts I had read were from the Emmanuel Clinic, not Jerusalem.  We walked in and the waiting area had two couches, a reception area and elegant decor.  The driver brought our luggage in and we waited to be called back by our on-site coordinator, Servetio.  

Servetio called us back one at a time (Lynne and I were the only people waiting) and did a pre-op consultation and medical history form.  He confirmed the type of surgery and went through questions about my parents health, my health, my eating habits, medications I was on, etc.  He also weighed me and I found out I was already down 8 pounds since my pre-op diet!  Servetio also offered to answer any questions we might have and explain the entire process.  I felt like I had a good idea already just from reading the boards so much :)  He even explained that HE had had the VSG one week prior!  One week!  Wow.  He said he had already lost 15 pounds and was back to work almost immediately.  He was fantastic and was with us throughout the whole process.  He spoke fluent English and was very helpful.

I returned to the waiting room and then was called back to be put in a patient room and put a gown on.  Apparently I put it on backwards.  I couldn't figure it out and my roommate couldn't either!  Ha.  As a side note, put it on like you are wearing a robe and the opening is at the front and then it ties on the side.  I felt so silly! :)

After Lynne had her EKG, I was called back by the cardiologist for an EKG.  He had a portable EKG machine and explained what he was doing.  His English was not very fluent but it was obvious what he was doing and what he needed from me.  He asked a few questions about my medical history pertaining to my heart and when my report was printed, he commented that I was healthy :)  I thought to myself, "yes, except for being overweight...".

When the doctor was finished with my EKG, Servetio brought Dr. Almanza in to speak with me.  Servetio helped translate if there were any problems but for the most part, I could follow what Dr. Almanza was saying.  He explained to me what was going to happen during surgery and that he would make 5 incisions and remove part of my stomach.  He said that the surgery would take about 90 minutes and also explained what he wanted me to be eating (drinking) for the next few days and the sequence of foods over the next few weeks.  He said at 4 weeks, I'd be on a normal diet.  He was a very kind man and sat down with me to explain everything. He and Servetio also told me that when I moved to the recovery room after surgery, that I would be VERY cold and probably not remember it. He also explained that everything would be done under general anesthesia and I would be intubated.

When I returned to the patient room, a nurse came in to put my IV in.  I was a little bit nervous about this because some people just don't have good veins and I hadn't had an IV in 18 years!  First time--first spot and I was good to go.  

I went back to the room and waited for my turn.  Lynne was first and they told me that it would be about an hour until they were ready for me.  By 11:45, I was taken in to surgery.  I walked to the operating room and this is what I remember:  I laid down and the anesthesiologist was standing over me.  He explained that I would be going under general anesthesia for surgery and.....yup.  That's it.  The next thing I remember, I was SHIVERING like mad in the
recovery room.  My first thought was that I wish my dog was there because he could help warm me up under the covers.  Haha. Surgery was over around 1pm.   

My husband was told I was in recovery and the staff told him that he could see me but reminded him that I would be very cold and would probably not remember anything or be coherent for about 30-45 minutes.  He tells me now that he could not believe how cold I was and there were a ton of blankets on me and the heater was turned on.  He also remembers that my lips were blue but that was most likely from one of the leak tests done during surgery.  I vaguely remember Dr. Almanza coming in to check on me and I verified later that he said everything went well and that he only had to cut me three times.  I remember asking if I looked okay inside (I was worried after reading about people having to go on a liver-shrinking diet) and he said yes and that is why I only would have 3 incisions.  I was in the recovery room for about 3 hours.

When I was finished with the initial recovery, I was moved back to my room.  Lynne, the lapband patient was already chewing ice and I was a bit jealous--I had a very dry mouth and that lasted about 28 hours until I was allowed ice the next day.  Lynne left later that day because she had a much shorter recovery time for LapBand and my husband stayed in the bed next to me that night.  I remember being in my room about an hour or so and when Servetio checked on me, I asked when I could start walking and he said that I was fine to start then.  The gas had really built up in my back and shoulders and I was willing to do whatever it took to start simmering it down.  My husband and I walked the hallway as much as we could.  We continued to get up to walk, then go back to laying down off and on throughout the rest of the day/night. At this point, I was using my husband to help me get out of bed and that only lasted about 48 hours until I felt I could pull myself up without help. (Granted, he was there so of course I was going to use him!)  

I was allowed one Gas-X strip per day and I don't really know if that helped at all.  I was getting medication in my IV for the gas, nausea, pain and antibiotics.  I was also given a mint on the first day to help with my cotton-mouth, as well as being allowed to swish water around and spit it out.  I don't remember any significant problems the first night.  I slept through the night and aside from gas discomfort and not being able to roll around, I was comfortable.  The gas was rough though and I did use my heating pad for a little while but since it was a microwavable one, I couldn't keep it hot long enough to really be of use.  It did help while it was hot, though.

My husband helped me to the bathroom on day 1 and once in the middle of the first night.  He really was just there so I could use his hand to pull myself up and to stand at the door where my IV cart was.  The nurse came in during the night to give me more medication as scheduled, as well.  (Pain and antibiotics)

The morning of "day 2", Servettio came in with a towel and told me I could take a shower.  I thought that that would be a chore but we knew it would make me feel better. Between the IV and the drain for my stomach, it certainly was not easy but it felt a lot better to be cleaned up and semi-normal.  My husband helped me with the shower by being in there in case I needed anything.  He shaved while I showered.  My IV came out during the shower.  Not the whole thing from my hand but the part that connects.  As soon as I got out, I went to the nurse and they gave me a new one.  The nurse also came in to change my bandages since they were all wet.  I wasn't really sure if I was supposed to shower with them on or not. Every day except on day 5 and on, I showered with them on and then had them removed, cleaned and changed right afterward.

Day 2 continued by being moved upstairs into a differnt patient room with a new roommate.  At this point, the Clinic was filling up and there were about 4 of us who had had surgery on the 13th recovering and another group waiting for surgery that day.  I slept, laid down, walked and counted the minutes until I could have ice.  In the afternoon on day 2, I was given a cup of ice and chomped on that delightedly.  I was feeling pretty good and even got online for a little while.  My IV was taken out and I would have to get an injection in my rearend which was to be a super-high dose of antibiotics.  The nurse told me it would hurt.  It hurt.  A lot. For about 15-20 minutes and it felt like hours.  It burned in my bum and I tried to rub it and it actually brought me to tears. I asked if it was normal for it to still hurt and Servettio said that some people it only hurts for about 5 minutes but everyone takes it differently.  That was rough.

I finally got over that and was relaxing again. By this time, I had seen Dr. Almanza about 3 times and Dr. Betancourt about 5 times.  Dr. Betancourt owns the Clinic and is the master of operations (not sure how else to put it).  He is in charge and checks up on patients and helps coordinate things medical and personal. Since the Clinic was filling up and it was clear my husband would not have a bed to sleep in, Dr. Betancourt said that he would be paying for us to stay at the Marriot in Tijuana.  

In mid-afternoon, a driver took us in Dr. Betancourt's private vehicle with our luggage to the Marriot.  I was a little nervous not being in the Clinic in case I needed any medical attention but they clearly chose us to go based on how well I was recovering.  A few hours later, a driver returned with my medications that I would need to take every 8 hours since I was no longer on an IV.  (Pill antibiotics, pill pain pills and liquid anti-gas/anti-nausea).  We were told we would be picked up in the morning, around 9am, to be taken for the blue-dye test and the contrast liquid swallow x-ray (both are to check for leaks).  By this point, I was able to drink water and was still eating ice at the hotel.

We received a call around 8:30 that the car was on its way.  We were taken back to the Clinc so that I could drink the blue "stuff" and have my drain emptied and checked.  The drain needed to be emptied about once per day until it was taken out.  It works as a suction for any drainage in your stomach.  The contents looks like Hawaiian Punch.  Everyone has one.  

I drank the blue "stuff" and it was nasty.  It tasted like watered-down paint.  And it was blue.  And it was dye.  Which means my teeth and tongue were now blue after getting down about 7-8 solid sips.  We left with one other patient and all of our luggage to go to get our x-rays.  This lab was about 15-20 minutes away from the Clinic.  When we got there, there were already quite a few people waiting for ultrasounds and x-rays but we only waited about 10 minutes before being called back individually.  I had to stand up on a platform while an x-ray was taken.  Then, I was given contrasting liquid that I had to hold in my mouth and swallow when prompted by the technician.  I heard later from other patients that if I had turned my head, I could have actually seen the liquid going down and filling my new (much smaller) stomach.  Honestly, the taste of the contrast liquid was gross and I was just trying to distract myself until I could spit to clear my mouth.  The technician came out and showed me my stomach on the screen and since it didn't look *exactly* like the cartoonized images I had seen online, I asked him if it was small and he said, "oh yes, very small".  Okay, great!

I went back in the waiting area and had a cup of water as we waited for the x-rays to be printed out.  About 5-10 minutes later, we received our x-rays and were on our way to the recovery house.  The recovery house is only about 5 minutes from the Clinic so it was about 20 minutes from the X-Ray lab.  

We arrived at the house and were shown to our room.  I can't believe it was only Day 2!  I wasn't moving quickly and I actually used a pillow to hold over my stomach while we drove for x-rays and back.  As a side note, let me say that the drivers for Jerusalem Clinic are AMAZING.  They are SO conscientious of our sensitive bodies and avoid speed bumps, slow down for potholes and do not drive at all the way most of the Mexicans on the road were driving--which was crazy! :)  

On day 2, we settled in to the house and had our first bowl of chicken broth.  This bowl came from a can of chicken noodle soup that was strained. I was curious why they didn't just buy plain chicken broth and was told that the broth has a much better flavor when it comes from the noodle soup and they were right!  I never even thought of that!!  The cook made my husband chicken fajitas and although they smelled and looked great, I remember thinking that they
didn't even seem to tempt me.  It would take a few more days until I actually felt hungry again---and I think that is understandable since it had been 6 days since my last "bite" of anything and that was during the pre-op diet!

I slept pretty well at the house. It was a *****illy as the nights in Tijuana cool down quite a bit.  Ther are plenty of blankets on each bed (we were in a room with 2 single beds, TV, DVD player) and there was also a space heater in the cabinet in each room.  We used it the next night.

On day 3, I was very much hoping to have my drain taken out.  When I saw Dr. Betancourt the night before, he told me that he'd check it in the morning and depending on how much drainage I had, I might be able to have it out.  I went downstairs early to wait for him to check me out. When he arrived he remembered to check me and I was cleared to get it pulled!  I have to say, the feeling of the drain being pulled out is just uncomfortable but not really painful...it was just weird.  It felt like a suction inside my stomach (which is exactly what it was) and I remember moaning and groaning and telling the nurse that I was a baby :)

I was so happy to have the drain out and eventually showered again and had my bandages changed.  My husband and I would walk the block where the house is multiple times, especially after I ate...that seemed to help everything settle in.  I was constantly with a glass of gatorade or juice or crystal light (which I brought my own packets of).  On day 3, I remember waking up to use the bathroom and my urine was darker and my mouth was dry so I made it a point to drink even more....staying hydrated is one of the keys for recovery.

In the later afternoon of day 3, Sylvia, one of the nurses and cooks at the house, told us that there was a party going on at Dr. Betancourt's house across the street and that is where everyone was.  We headed over there and were welcomed like family.  We all sat and chatted and shared stories and eventually,

Sylvia made dinner for everyone.  There were 3 people eating "real" food and the rest of us had a delicious homemade chicken broth.  Shortly after dinner, I knew I needed to walk it out and we excused ourselves but returned after a few laps to get back into the fun.  This was the first time I could eat while sitting down.  Up until then, it was too uncomfortable and I had to stand--luckily the main recovery house has a high-top dining table.

We made arrangements with the driver for day 4 (Sunday) when we would be crossing back into San Diego.  On day 4, Sylvia made us breakfast at Dr. Betancourt's house again (broth) while the guys had a ham and egg scramble with beans and fresh tortillas.  After breakfast, we chatted more and then packed up while we waited for our ride at 11am.  Around 11am we headed to drop off one patient and her boyfriend to their hotel and then were at the border (in line) around 12pm.  The driver had already been across one time and said that the wait was about 1 hour.  This was excellent news to us because we had heard to plan on 3-4 hours.  I am not sure if being Sunday made a difference or if it was because it was in the middle of a 3 day US weekend (MLK, Jr Day) or if it was just our luck :)---but it took almost exactly ONE hour.  Phew!  

During the border crossing, I had no idea how many peddlers would be selling their goods....food, blankets, jewelry, drinks, clothing, religious items, everything.  It was interesting to watch and I suppose it helped the time fly by---especially when the police came by and the guys without permits went running.  

We were asked what we had at the border and if we had any medications. I told them that I had my pain killers and antibiotics from surgery and showed him the amount and we were on our way.  The driver from Jerusalem brought us all the way to our hotel instead of just the airport since we were not actualy flying out yet.  We found the Radisson on Hotel Circle South in San Diego; about 2 miles from the airport with a shuttle, a full restaurant and even a pool outside if my husband wanted to get in!  (He didn't but we did go to the restaurant for dinner).  This hotel cost us $81.05 and was heads up the Days Inn that we stayed in pre-op.  Much nicer and cheaper!  There was the big San Diego Chargers v. NY Jets NFL game on this day so we had to wait about an hour until a room opened up at the normal check-in time but that was fine.

And that brings me to now.  We are getting ready to head to bed and wake up for a 5am shuttle ride back to the airport for our day of traveling.  We fly the same route back that we did here:  San Diego to Atlanta to Pensacola.  I went online while we were in Tijuana and requested wheelchair assistance for myself just in case and to possibly give us a priority.  

I haven't taken any pain medication since I was on the IV.  I have only take the anti-gas/anti-nausea liquid medication about once per day and will probably leave it in San Diego because I forgot to get a note saying that it was medically neccesary for me to carry it and we are not checking any bags..and it is too much liquid to carry on.  My antibiotics of course are pills and stay close to me in my purse.  The vending machine here at the Radisson had a cup-o-noodles and we bought that so I could have broth during our long flight tomorrow if I wanted it.  I figured the flight attendants would have ho****er for tea so I might as well have some broth.  :)  

I plan on writing a MUCH shorter blog about what to bring if I were to do this over again (I wayyy over-packed).  If you've read this far, kudos to you!  I know I searched and searched for as many play-by-plays as possible before I left and I hope this helps set someone's mind at ease that is preparing for surgery :)  If I ever can convince him, I'll have my husband write a little blog from his perspective so that it might help some of you bringing guests with you.  He had not done any research as I took care of all of that but he speaks very highly of this whole process and is astounded at how well we were treated and accomodated at all times.  Good luck to you and feel free to ask me any questions!



     

HW: 251  SW: 243  CW: 146  Height: 5'6.5"

goldiekat
on 1/20/10 11:14 pm - Vega, TX
Thanks for the play by play of your time, it helps a lot as my date gets closer and closer (the more nervous I get).  Do you have any pics? 
Goldiekat^..^ Jeanette Petersen
Mother of three skin kids, three dogs, two gliders & two bratty cats
Eme 2009
on 1/20/10 11:17 pm - FL
You know, the only pictures I have are of me sitting in my gown waiting for surgery.  I had my camera with me but since we were all pretty much looking like a hot-mess, I never wanted to take any pics.  Sorry!
     

HW: 251  SW: 243  CW: 146  Height: 5'6.5"

mom.of.6
on 1/21/10 12:19 pm
Wow that was wonderful to read!! Thanks for posting it. My surgery is on Feb. 16, 2010 and I can't wait!
hollykim
on 1/22/10 2:13 am - Nashville, TN
Revision on 03/18/15
I will be there Feb 18 for mine. Maybe I will see you at the recovery house.

Good luck!
Holly

 


          

 

ebroady23
on 1/21/10 9:27 am
Thank you so so so so much. This help ALOT. I was wondering how your post op care is going. Are you having trouble with American Doctors?
Eme 2009
on 1/21/10 9:13 pm - FL
I met with my PCP in December to tell her my plans and ask for her support.  (I blogged about that, too :) ) She supported me and is willing to do anything I need (like ordering bloodwork, checking on my incisions, taking out the stitches, etc.)

I am actually going to have my husband take my stitches out this weekend because tomorrow will be 10 days and I do not want to wait too long (my PCP isn't available until Wednesday).  I plan on seeing her, though, because I'd like a prescription for a medicine that will help prevent gallstones. 

Aside from that, my post-op care back at home is just:  take my antibiotics every 8 hours and clean my incisions.  I use Hibiclens that I bought from Wal-Mart. 

It really gave me a lot of peace of mind before I left to talk to my PCP and I actually scheduled an appointment for 2 days after I returned---just in case I felt I needed her immediately! :)  I have since rescheduled that until next week so I can get the Rx started at about 2 weeks out. 
     

HW: 251  SW: 243  CW: 146  Height: 5'6.5"

PTibbits09
on 1/21/10 4:42 pm - North Las Vegas, NV
This is AMAZING and makes me feel so much better! I now have an idea of what to expect in 7 more days! :D
Eme 2009
on 1/21/10 9:16 pm - FL
You guys will be great!  Make sure you speak up if you need something (or have whoever went with you do it for you).  The staff is genuinely there to help but know that with any medical facility the staff can be overwhelmed and wont always know when you are needing something. 

Of course, they check on you often but I found it most helpful having my husband ask for things for me (like when I returned from the shower, I'd lay with my shirt up and he'd go ask a nurse to come in to change my bandages.) 
     

HW: 251  SW: 243  CW: 146  Height: 5'6.5"

Irishsweettart
on 1/22/10 3:15 am - North Las Vegas, NV
Thanks for your insight, we go next friday :)  We are bringing my sister with us, who is a doctor, so I feel a little less nervous, but your blog helped alot!!!!!
            
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