Question about Dr. C and his bougie technique

You are VERY easy to be patient with!

Unfortunately I only see the first picture, but that cat is stunning.  I have a big fondness for those and Maine Coons.  Sadly, I had to put my 20 yo baby boy down on April 30 as we felt he was suffering.  I am not good at pics otherwise you would have gotten to enjoy his long white hair and black nose, along with his 12 yo buddy who is pure black long hair and our baby Lucy (4) who is a long haired tortoiseshell who is in dire need of a VSG.

Yep, I'm a cat nut, you can check my earlier post if you are interested.

http://www.obesityhelp.com/forums/unmoderated/4530850/LOL-cats-Mothers-day-edition/

Hugz right back!

So sorry about your fuzzy's passing.  How fortunate you are that you had 20 years with him.  NFC's see a higher proportion of Hypertrophic Cardiomyopathy and Cocoa and Shugy were both diagnosed with it.  I never thought Shugy would go first.

I loooooooooooooove torties!!!  Adore them!!!

Did check your earlier post and enjoyed it immensely.  Love those LOLcats!

 Were/are your NFC's large/heavy cats?  Lucy was 19.8 lbs a few months ago, but should be about 10-12.  It's hard to control it, when our other(s) were thin.

Generally speaking, NFC males can get pretty big, though not as large as Maine Coons.  My Shugy was about 19-20 lbs at his top weight.  Cocoa, however, has never gotten heavy.  He is a large framed cat, but only weighs about 12 lbs.  His doctor says that is a much more healthy weight for him, especially because of his heart conditions.

It's amusing that I so often see the same thing with pets and children.  One needs to eat less and the other needs to eat more.  The heavier one is always willing to glad to eat the other's leftovers since "he doesn't want it."

http://www.nxtbook.com/nxtbooks/matrix/bt_supp0609/#/3/OnePage

The above is a link to a publication called barriatric times in which cirangle and jossart and others have an article that tells a little bit about why they do the sleeve as they do.  i don't think it has all you need but might help.

good luck with your vsg. diane

Hi Diane!

Thank you so much for this link.  I don't know what I was thinking when I wrote my original post!  Now that the VSG could become a reality very shortly (I only have 6 lbs to go to be eligible), I started obsessing about all the things I can't control.  One of which would be how the surgeon actually does the surgery.

When I do see him next, the information in this link will help me ask more intelligent questions.

Thank you, as always!

Anita

 Hi Angel's Mom, you sexy beast you -

So Cirangle has actually published a few things about his sleeving technique - these scientific and medical papers aren't indexed in Google very well, they're in PubMed, but you have to know how to query that properly - it's a temperamental database and you won't have access to a lot of the journal articles.  If you want, I can send you Cirangle's papers (I have subscription access as a scientist - PM me with your e-mail address and I'll send some PDFs).  Cirnagle talks largely about two things - not just using a small bougie size and how to minimize the occurrence of leaks which could increase, but just as importantly, the need to properly shape the stomach into a natural banana-like curve rather than an L-shape which could cause a stricture!

BUT... and this is a bit butt (har har) - I've got to echo Frisco (again at the risk of people thinking we're the same person) that you wouldn't actually want to hand these papers off to your surgeon and say "Here, do this to me" like it's a new recipe for cupcakes.  If this guy has no experience with using a small bougie and crafting a smaller sleeve, you do not want to be his first attempt.  You just can't ask a surgeon to work outside their comfort zone and hope for good results.  Gotta find the surgeon you want.

I hit this recently with my selection of plastic surgeons.  I'm getting a lower body lift in less than one month and consulted with seven different surgeons.  Two of them were uncomfortable doing the entire procedure in one operation; they wanted to break it up into an abdominoplasty now and a thigh/butt lift later.  Rather than fight / argue / persaude them, I just have to say "see ya" and proceed to another doctor who's attitude is "yeah I do this all the time, this is normal for me, no big deal". 

So two sides here - I like to stack the cards in my favor and wanted to pick one of the best surgeons I possibly could.  I was lucky to find Cirangle was in my back yard and wouldn't even have to fly in order to select him as my surgeon.  I was impressed with his philosophy and his publications describing his technique.  Moreover, I love his aftercare support - his office staff is always there for me, and always made time for me, and Cirangle is great in his support groups.

The other side here is that there are plenty of examples of people who still attain reasonable amounts of weight loss - in fact, even hit 100% EWL still with a larger bougie stomach.  It may or may not take them additional time, and these people may or may not be slightly more subject to easier regain with a stomach that's bigger a decade down the road.  Who knows?  The point of this side is that maybe either (A) the operation itself is enough and bougie size won't matter or (B) it does matter, but maybe not enough to encourage you to travel four hours and pay out of pocket instead.  

My choice was easier - Cirangle was a two-hour drive for me and my insurance covered it so it was pretty much a "hell yes" decision for me.  So... I don't think there's a "clear" decision you can make here (other than not trying to have a surgeon operate outside his comfort zone).  You have to rank what's important to you.  Statistics and odds of success, your emotional state, traveling or not travel ling, finding another surgeon or not, paying out of pocket or not, guessing how bougie size affects your success not just in weight loss but in the majority of your life - the maintenance phase.  At the least you can say "If I get some sort of WLS by some kind of surgeon I'm going to lose a good deal of weight".  Is that enough?  Only you can answer that for you.

I hope you found this somewhat helpful.

Hi Ruggie!

Hahaha, I think my sexy beast days are long gone!  These days I'd be satisfied to be a MAWWLPDGIHC.  Middle Aged Woman Who Looks Pretty Damn Good In Her Clothes!

I plan on channeling Elina!

I appreciate the offer of any information you can give me.  I am a little embarrassed for posting this question because I really do know better.  I haven't seen Dr. Crooms in over 18 months.  He had already done a few VSG's at that time.  I'm sure he has done more by now, especially since the major health insurance carrier in Tallahassee has approved the VSG finally.  He already has a very good reputation as an excellent surgeon.

My biggest problem, which I am sure everyone can relate to, is that I only have 6 pounds to go before I am eligible.  Then it will become a reality. From the minute I heard of the VSG, I started researching it  endlessly.   I have read hundreds and hundreds of posts here on OH in the last 2 years.  I have saved many of them and plan to make a kind of manual for myself so that I can anticipate issues we all run into and will have answers right at my finger tips.  I have so much head knowledge that I could practically be an advisor for some of the more basic questions.

The problem?  The what ifs.   You and everyone else already know what they are, so I won't even bother to type them.  I can control my knowledge of VSG life.  I have been able to control my feelings with food.  The hand of the surgeon can not be controlled by me.  Life's ups and downs can not be controlled by me.

I almost feel as I did the night before my daughter was born.  I was PETRIFIED!  I decided that I was just not going to give birth.  Not too sure how I planned to accomplish being pregnant the rest of my life, but it was a moot point since babies rudely insist on being born anyway.

I like what you said about stacking the cards in your favor.  This pretty much sums up what I am trying to do.  Every thing I do is an effort to stack the deck in my favor.  The last 3 weeks where I am in my final drive to lose the pounds to be eligible I have had to take eating on a day by day basis.  Many times on an hour by hour basis, and even more on a minute by minute basis.  I have had to white knuckle it through sometimes, so that I eat what I need to eat to get to my goal.  Curiously enough, I've been following a VSG food plan of sorts, protein first, etc.   I think this is probably very good practice for me for afterwards.

I hope that it will be all right for me to ask the Maintenance Group some non-maintenance questions during my losing phase.  I really don't have a lot of confidence in the advice I might receive from the regular board.  I may not feel the need to eat a McDonald's breakfast sandwich, but the last thing I would need is someone advising me that if I feel really bad that it couldn't hurt that much to eat a pint of Ben & Jerrys as long as I don't do it again.  Of course, if I really did ask a question like that, I would certainly deserve the 87 irritated responses in return!

Thank you so much for your patience and encouragement.  I had abdominoplasty several years ago after a large weight loss.  I never, ever, ever regretted it.  Especially now, because I couldn't afford it now.

Hugs!

Anita

PS - Sending you my email address by PM

 You're quite welcome -

I like to think we're all a family here.

And if you're going to channel Elina, then you're going to need to shop for red pants.

 
Here is just another tidbit about technique......

The shape is very important for a number of reasons, with food flow being one of them. A very common error with and a reason many surgeons stay away from the smaller sleeves is that some tend to get it to tight in the middle....at the curve where the bougie naturally butts up against the spine of the stomach.

Another tidbit..... the staple cartridges are straight and the surgeon needs to be able to make a curve with a straight row of staples. On top of that it takes multiple staple cartridges to complete a staple line and at the end....the newly crafted sleeved must lay flat without any kinks or twisting.
Imagine trying to make a curve with a ruler.......

Not an easy thing.....

frisco