Guest guest Posted May 24, 2000 Report Share Posted May 24, 2000 This letter was written 2-3 weeks ago--- In MiniGastricBypass (AT) e, " " wrote: > > It wasn't any one thing. Some of it is just personal to me and your > personal reasons could tip the balance in an entirely different > direction. > > Bottom line: Compared to Fobi and RNY, Rutledge's procedure produces > the same weight loss, has far less " under anaesthesia/in surgery " > time, less hospital time, lower hospital costs, less stay-in-the area > time and expense, less pain/recovery, has the same or less > complications afterwards as any other procedure, but allows you to > still eat reasonable sized portions afterwards. After I contacted 90 > of his patients and got great feedback, it was a no-brainer to me. > > All the procedures, the Fobi, the RNY, and Rutledge's procedure, have > a pretty good safety record, and similar weight loss results (almost > identical, actually). > > All the procedures (Fobi, RNY, and Rutledge's) have the risk of > obstructed bowel, ulcers, etc. None seems to be any more or less > safe > than any of the others > > (NOTE: I am *not* including that " Duodenal switch " procedure in any > of this. If you look at that and notice that you are cut from stem > to > stern and have a lot of potential complications, etc. from it, that > was *right out* to me.) > > With *no* procedure did I find that the majority of patients were > reaching their goal weights. *All* the procedures leave the majority > of people still " obese, " though less obese than they were, but 30- 70 > pounds overweight at about 14 months. > > Any of these procedures, done as an " open " procedure, instead of > laparoscopic, will leave a big scar, and you will be in pain a lot > longer and have about a 6-8 week recovery time. You're also at risk > for complications from the incision itself, including hernia and > infection. You're on the table under anaesthesia a lot longer, too > -- > as much as 4-7 hours. I'm a pain wuss, and (I'm the Barbie Wannabe, > remember?) scarring is a *BIG* deal to me, so the open procedure was > scratched from my list pretty early. > > Any of the procedures (Fobi, RNY, Rutledge), done laparoscopically, > will have a 1-2 day hospital stay, less pain, and leave 5 > trocar-sized > (about 1 inch) scars. The Fobi and RNY take 4-7 hours on the table > under anaesthesia, Rutledge's procedure takes 30 min. - 1 hour. I'm > of the opinion the less time in surgery under anaesthesia, the better > for the heart and brain. Hospital charges are less, too. The > after-surgery recovery time was shorter for Rutledge patients and the > required stay in the area after surgery was shorter. > > None of the places offering a laparoscopic procedure were close to me > and required you to stay " in the area " anywhere from 1-3 weeks after > surgery. The costs of travel and lodging were significantly > different > depending on where the clinic was located and how long I would have > to > stay out there after surgery. Rutledge had the shortest mandatory > after-surgery stay, and was also in an area where prices were lower, > generally. I also discovered on travelocity and priceline that there > were some *great* prices ($130 round trip) to Durham. Extended Stay > America's kitchen-equipped rooms are $270 for 7 days for 2 people. > > > Now, personal to me: > > I'd already spent a *lot* of time, first, getting approved by > insurance, then, after finally getting approved for the Fobi > procedure, deciding against it. > > I was convinced against the Fobi group by numerous patients who were > having trouble with incisions coming open after surgery, as well as > other complications such as obstructed bowel, hernia -- all happening > to people on the Fobi list within a 3 week period. Too many to suit > me. They claim they have a " low " complication rate, but they give it > in " percentages, " and I was hearing first hand from far too many > people with complications. I got run off the Fobi list when I asked > about these problems. There was a sort of moonie mentality on that > list that defied common sense and I'm a no-nonsense, give-me-facts > kinda person. > > [Let me interject here that I have found the people on the Rutledge > list to be a lot more involved in their pre-and post surgery than on > other lists, asking lots of intelligent questions, and giving and > getting intelligent answers -- another plus, and I'm not discounting > Dr. Rutledge's dogged determination to educate everybody whether they > want it or not, either. ] > > Then I saw pictures of a woman, my size, who had the exact same > procedure I had planned to have, where the doctor does a > panniculectomy ( " tummy tuck " to remove all the overhanging stomach) > and uses a low, bikini incision for both the panniculectomy and the > RNY, thus leaving no scar on the upper abdomen other than one small > 1/2 " incision (plus the hip-to-hip bikini line incision). The belly > button is moved during this procedure, too. Well, her pictures are > up > on the web at 14 and 27 days post-op and her belly and up to her > chest > is badly bruised and swollen, her incision is gaping in places (and > will leave a wide, ugly scar, from hip to hip) and her belly button > looked grotesque. It looked, in a word, brutal. I decided my flabby > belly was probably just fine. I'm 47, I should have some wrinkles. > > Oh yes, let me add that Roseanne had the Fobi done at the Fobi clinic > and if you've seen her, it's been over a year, and she's still fat. > > Now, last but not least, the Fobi clinic treated me like a damned > number. When insurance first turned me down, the Fobi clinic dropped > me like a hot rock. It was totally up to me to fight with insurance. > At the Fobi clinic, they have their process so " automated " that they > have a different person for *each* piece of paper (I'm not kidding). > So when I won the insurance battle and called the Fobi people again, > they at first couldn't find my file, then when they found it, I was > talking to a different person each day as " my paperwork " made it from > point A to Z, and there was no way to find out anything without > several phone calls, daily, just to get a human and not a voice mail. > By this time, the " process " had taken from February 1 to May 1. So, > in > a word, Fobi sucked. > > Fobi's group does not do the Fobi laparoscopically (so you're looking > at about a 6 week recovery time), but Dr. Marema, who studied under > Fobi and has had the procedure himself, does. Marema is located in > Ft. Lauderdale, Florida. I contacted him but had a lot of problems > getting anything scheduled with him, being an out-of-state patient. > Travel arrangements to Ft. Lauderdale were a logistical and price > nightmare from Southern Alabama, too, for some reason. I could go to > LA cheaper. > > His office is not set up for high volume and by that time, I was > getting pretty fed up with getting the runaround on the phone from > Fobi and then Marema's office, and running out of time. However, I > was > impressed with his standards and based on patient satisfaction and > information I gleaned about him, I would rate him A+. However, it is > a 2-4 hour procedure (even laparoscopically), which concerned me (he > does the lap Fobi which is similar to the RNY, but the Fobi procedure > also leaves you with a tiny 2-ounce stomach, so, yes, you will be > learning to eat like a bird forever. > > The Alvarado clinic in California does the RNY laparoscopically. But > Alvarado is a small practice and they've done a lot of " celebrity " > advertising (with Carnie , for instance) so they are over- busy. > Getting scheduled with them is really difficult. They don't have a > " patient packet, " and rely on phone calls a lot, but when they are so > busy, and only have one person handling the phone calls, it makes it > pretty impossible. They also were the highest-priced of everyone I > checked. (They're in LA). I've got to pay a good portion of my > surgery, so that was a definite consideration. Additionally, their > surgery takes about 4 hours on the table. I've had surgery with > general anaesthesia and from your own health standpoint, the less > time > under anaesthesia, the better. Travelling to CA and staying out > there > three weeks was also going to cost about 5 times more than staying in > North Carolina a week. > > I heard about a really good doc who does the RNY laparoscopicically > just outside of San Francisco, Dr. Gracia, but by the time I'd heard > of him, I had already submitted my packet to Dr. Rutledge and was > pretty happy with the decision. The one thing about this doctor that > got my interest was that he does vary the procedure by the patient (a > distal RNY, as opposed to a proximal RNY, will produce more weight > loss, whereas Rutledge seems to be totally inflexible on how much > bowel he will bypass) and he is world-renowned for his laparoscopic > skill. I simply didn't have any more time to pursue this, though. > The lap RNY has a longer surgery time, longer recovery time, and > greater expense (hospital), as well as the expense (for me) of going > to CA, so I likely would have decided against it anyway. > > Dr. Rutledge has both a good track record and *excellent* patient > relationships. That's a big plus in my book. I got back 90 patient > contacts and all the patients love Dr. Rutledge. There were very few > complications in the bunch, too, with most people reporting having > surgery, pain the first day, not much the next day, doing fine by the > third day and no complications. > > However, caveat, the only statistics I could get for Dr. Rutledge's > procedure are all people 2 years or less post-op. I'm disturbed > about > this. I would prefer to hear from people 5 years out. Did they gain > the weight back? Did they develop ulcers? Vitamin deficiencies? Did > any of them reach their goal weight? What percentage? > > With all the information Dr. R. otherwise makes widely available and > with all the statistics he keeps himself, I'm surprised that these 5 > year figures -- the ones which the National Institute of Health > itself > would use to evaluate the effectiveness of the procedure -- are not > available on Dr. Rutledge's webpage. > > Maybe he'll share this information with us? > > Anyway, after a point, enough is enough. > > I had been putting off taking a new job until I had this surgery and > I > was going broke waiting. It was time to get off the pot. > > Dr. Rutledge had a lot more " plusses " in his column than any of the > others, for a variety of reasons and I never found anything to change > my mind. > > I'm scheduled on May 18. All prayers appreciated! > > > > > > Hi : > > > > I know you did a lot of research about wls and I was wondering if > you would > > share with me, and anyone else interested, what in particular made > you > > decide to go with MGB. > > > > Flo from land Quote Link to comment Share on other sites More sharing options...
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