Why I picked Dr. Rutledge -

[Guest guest]

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