RE: St. 's University Hospital

July 4, 2001

Cindy,

I may be wrong, but the last time I checked, Brolin was still only doing RNY's.

Marcia

-----Original Message-----From: Cinloo59@... Sent: Wednesday, July 04, 2001 12:24 PMTo: duodenalswitch Subject: St. 's University HospitalHey all Listen, I was wondering if my emails are getting through....darn computer Anyway, I was hoping that someone might have heard about this hospital and it's Dr. Brolin in NJ....he is doing DS but only open and I keep going back and forward on this because he is sooooooo close but I'm not sure about having it done open...correct me if I am mistaken but there seems to be more incidents of hernias and infections with an open DS...and healing is longer...yes?.... Also, has anybody here ever had surgery done in one place but joined the support group in another hospital? I know that quite a few of you have had surgery out of the country or at least out of your own state....do you look for a support group or not bother....? Does anyone have any feelings about support groups in general? The one I'm thinking of is connected with St. 's and they meet once a month and do picnics and BBQs and pool parties together..not to mention the regular trading of info and experiences... Cindy S ----------------------------------------------------------------------

July 4, 2001

Hi Cindy:

> it's Dr. Brolin in NJ....he is doing DS

> but only open and I keep going back and forward

> on this because he is sooooooo close but I'm not

> sure about having it done open...correct me if

> I am mistaken but there seems to be more incidents

> of hernias and infections with an open DS...and

> healing is longer...yes?....

I'm not sure about the hernia issue. A lot of people say that lap

has a lower incidence but I'm not sure if there is good evidence to

back that up.

As for healing, it does take a bit longer for the open incision to

heal, but I don't think that's particularly important, because the

surgery itself, i.e., the rearrangement of your insides, is what

makes recovery from this surgery less than a walk in the park. And

that recovery time tends to be a lot longer than it takes for either

type of incision to close.

As for infections and other major complications, that seems to depend

on your surgeon more than the technique. For example, the surgeons

at NYU had these results with their first fourty patients:

" There was one 30-day mortality (2.5%). Major morbidities

occurred in 6 patients (15%), including 1 anastomotic leak

(2.5%), 1 venous thrombosis (2.5%), 4 staple-line hemorrhages

(10%) and 1 subphrenic abscess (2.5%). " (1)

In contrast, Dr. Rabkin in San Francisco has performed something like

200+ lap DS's, with major complications in only 6% of patients, and

zero deaths. (2)

One potential problem with the lap DS procedure is that most lap

surgeons do not measure the entire small intestine. Instead, they

simply use a standard length, (often 250 cm), for the alimentary

(food) channel. Most surgeons who perform the procedure open, on the

other hand, measure the small intestine and divide it either at the

rough mid-point or at about 40%.

A study done on the BPD (without the DS) suggests that this

difference may be important. " With the equal limbs the incidence of

hypoproteinemia was reduced from 8% to 2% and the incidence of iron

deficiency anemia decreased from 20% to 10%. " (3) (I've never found

a similar study concerning the BPD/DS, so I don't know for sure if

the conclusions are transferable, but it seems logical that they

would be.

The point is that, regardless of whether you choose open or lap,

finding the best possible surgeon you can get, (within your own

financial, insurance, personal, and other limitations), is ABSOLUTELY

CRITICAL. Unless you simply canot travel, DON'T choose your surgeon

exclusively by his/her proximity to where you live -- this is much to

involved and potentially dangerous procedure to treat in a cavalier

fashion.

I've written a sort of guide/checklist on how to choose a surgeon.

I'll attach a copy to the end of this post. Hope you find it

useful.

Good luck,

Tom

p.s. Here are the references cited above:

(1) Ren CJ, E, Gagner M, " Early results of laparoscopic

biliopancreatic diversion with duodenal switch: a case series of 40

consecutive patients. " Obes Surg (Canada), Dec 2000, 10(6) p514-23;

discussion 524

(2) http://www.pacificsurgery.com/index.html

(3) Clare MW, " Equal Biliopancreatic and Alimentary Limbs: An

Analysis of 106 Cases over 5 Years, " Obes Surg (England), Aug 1993, 3

(3) p289-295

p.p.s. Here is my guide to choosing a surgeon.

-----------------------------------------------

Many pre-ops are befuddled by the question of how to choose a

surgeon. To help out, I've written down my thoughts on the process I

went through to choose my surgeon. (Incidentally, my surgeon is Dr.

Anthone at the University of Southern California.) I've also

made sort of a form out of it. Feel free to use it as is, change it

in anyway you like, give it away, etc.

I hope you find this helpful.

Tom LaRussa

---------------------------------------

1. MEDICAL SCHOOL ATTENDED: ________________________________________

I look for docs who attended medical school either in the US or at a

well-respected school in western Europe or Australia/New Zealand.

Rationale: These are the best schools, and they therefore are

hardest to get into, and thus get the best students. (An argument

can be made for schools in former British Commonwealth countries, but

none of the surgeons I looked at attended such a school, so I didn't

have to deal with that issue.)

2. CHIEF RESIDENT?

YES NO (circle one)

I give preference to those surgeons who had been appointed as Chief

Resident during their residencies.

Rationale: Cream rises to the top. The chief resident is chosen by

the faculty as the best among that resident group. I want the best

working on me.

3. POST-RESIDENCY FELLOWSHIPS, ETC. ________________________________

______________________________________________________________________

Rationale: Again, the cream rises to the top, so winning a

competitive appointment to a post-residency fellowship is another big

plus. In particular, I like to see a surgical fellowship after the

residency because it indicates just that much more training and

practice under the eye of experts.

4. PROFESSIONAL CREDENTIALS

a. Is the surgeon certified by the American Board of Surgeons (or

its British equivalent)? http://www.absurgery.org/home.html>

(NOTE: This is an absolute requirement! If the answer is NO, go no

further!)

YES NO (circle one)

Rationale: This is the basic, bottom line certification that

says, " You are now a surgeon. "

b. Is the surgeon a Fellow of the American College of Surgeons (or

one of the Royal Colleges of Surgeons in Commonwealth countries)?

http://www.facs.org/index.html>

YES NO (circle one)

Rationale: Membership in the ACS, (denoted by the initials F.A.C.S.

after " MD " ), is voluntary, and requires recommendations from fellow

members, plus what amounts to an investigation of the surgeon's

practice history.

c. Is the surgeon a member of the American Society of Bariatric

Surgery?

YES NO (circle one)

Rationale: This is a professional/educational organization for

bariatric surgeons. If a bariatric surgeon were not a member, I

would certainly wonder why not. Don't they care about keeping up on

new developments?

5. SURGICAL PRACTICE Comments: ______________________________________

______________________________________________________________________

I prefer a surgeon who has practiced as a general surgeon for at

least a few years before starting to do bariatric surgery.

Rationale: I want a surgeon who is prepared to deal with any

eventuality, both in the OR and in the post-op period. I figure that

a few years practicing as a general surgeon gives them more exposure

to all the different kinds of problems that can crop up.

6. BARIATRIC PRACTICE

a. When, Where, and from Whom did they learn to perform the DS?

______________________________________________________________________

Rationale: I don't want a surgeon who learned how to do the DS by

watching a videotape. (NOTE: All of the DS surgeons I have ever

looked closely at learned the surgery from someone quite qualified to

teach it, so this isn't a big concern. On the other hand, this kind

of thing does on all the time in cosmetic surgery, so it's not out of

the question as more and more docs move into this field in the

future.)

b. How long has he/she been performing the DS? ______________________

Rationale: I don't want to be one of their early DS patients, while

they are still learning how to do the procedure really well.

c. How many of his/her patients have died? When and under what

circumstances?

______________________________________________________________________

Rationale: If the doc is uncomfortable giving me this information, I

would get worried about why he/she was uncomfortable.

7. RESEARCH AND OTHER STUDY OF OBESITY?

YES NO (circle one)

Comments: ____________________________________________________________

______________________________________________________________________

I look at whether the surgeon has researched/studied the root causes

of obesity, as well as whether the surgeon has studied the digestive

tract in detail.

Rationale: As much as possible, I'd like to have a surgeon who

understands what obesity is all about, and WHY the surgery works (or

does not work) and not just the technical aspects of how to

perform our surgery.

8. AWARDS/OTHER

______________________________________________________________________

I also give points if a surgeon has won awards for excellence, as

well as any other signs that the surgeon works very hard to continue

learning and improving as a surgeon.

Rationale: Awards for excellence are, hopefully, further indicia of

just that -- excellence. And, learning is a life-long process, not

just something one does once.

9. ACCESSIBILITY

______________________________________________________________________

Am I going to be able to get in touch with my doc in an emergency?

Also, when I go to an appointment, with whom do I meet, the surgeon

or some underling?

Rationale: The world's best nurse hasn't been to medical school, let

alone received advanced training in complex surgical techniques. I

want to know that the person in whose hands I have placed my life

with be there when I need him/her.

10. PERSONALITY

______________________________________________________________________

Once I've found a truly excellent surgeon, it's time to consider

whether I can get along with this person. Truthfully though, if the

surgeon rated excellent in the categories above, I wouldn't reject

her based on personality unless he were really an ogre or completely

unapproachable.

11. OFFICE STAFF ___________________________________________________

Is the staff at least minimally competent in doing what they do,

i.e., pushing paper around and scheduling stuff.

Rationale: I'm not entrusting my health and safety to the office

staff, so who cares if they are morons and/or jerks as long as I get

my appointments when I need them?

July 4, 2001

you can get a hernia with a lap too....

I have had 3 major abdominal surgeries including the DS and never developed

any hernias so it just depends on the surgeon and your body. If I had a

choice I would go for the open becuz there are more pro reasons for that

than the lap but that is me......I had no leak test as that was done in

surgery....my hubby had the lap so had to have the leak test by swallowing

some stuff.....he said it wasnt exactly a picnic and did hurt alot but then

sometimes men are bigger babies than we women are!

Judie

Re: St. 's University Hospital

>

> Hi Cindy:

>

> > it's Dr. Brolin in NJ....he is doing DS

> > but only open and I keep going back and forward

> > on this because he is sooooooo close but I'm not

> > sure about having it done open...correct me if

> > I am mistaken but there seems to be more incidents

> > of hernias and infections with an open DS...and

> > healing is longer...yes?....

>

> I'm not sure about the hernia issue. A lot of people say that lap

> has a lower incidence but I'm not sure if there is good evidence to

> back that up.

>

> As for healing, it does take a bit longer for the open incision to

> heal, but I don't think that's particularly important, because the

> surgery itself, i.e., the rearrangement of your insides, is what

> makes recovery from this surgery less than a walk in the park. And

> that recovery time tends to be a lot longer than it takes for either

> type of incision to close.

>

> As for infections and other major complications, that seems to depend

> on your surgeon more than the technique. For example, the surgeons

> at NYU had these results with their first fourty patients:

>

> " There was one 30-day mortality (2.5%). Major morbidities

> occurred in 6 patients (15%), including 1 anastomotic leak

> (2.5%), 1 venous thrombosis (2.5%), 4 staple-line hemorrhages

> (10%) and 1 subphrenic abscess (2.5%). " (1)

>

> In contrast, Dr. Rabkin in San Francisco has performed something like

> 200+ lap DS's, with major complications in only 6% of patients, and

> zero deaths. (2)

>

> One potential problem with the lap DS procedure is that most lap

> surgeons do not measure the entire small intestine. Instead, they

> simply use a standard length, (often 250 cm), for the alimentary

> (food) channel. Most surgeons who perform the procedure open, on the

> other hand, measure the small intestine and divide it either at the

> rough mid-point or at about 40%.

>

> A study done on the BPD (without the DS) suggests that this

> difference may be important. " With the equal limbs the incidence of

> hypoproteinemia was reduced from 8% to 2% and the incidence of iron

> deficiency anemia decreased from 20% to 10%. " (3) (I've never found

> a similar study concerning the BPD/DS, so I don't know for sure if

> the conclusions are transferable, but it seems logical that they

> would be.

>

> The point is that, regardless of whether you choose open or lap,

> finding the best possible surgeon you can get, (within your own

> financial, insurance, personal, and other limitations), is ABSOLUTELY

> CRITICAL. Unless you simply canot travel, DON'T choose your surgeon

> exclusively by his/her proximity to where you live -- this is much to

> involved and potentially dangerous procedure to treat in a cavalier

> fashion.

>

> I've written a sort of guide/checklist on how to choose a surgeon.

> I'll attach a copy to the end of this post. Hope you find it

> useful.

>

> Good luck,

>

> Tom

>

> p.s. Here are the references cited above:

>

> (1) Ren CJ, E, Gagner M, " Early results of laparoscopic

> biliopancreatic diversion with duodenal switch: a case series of 40

> consecutive patients. " Obes Surg (Canada), Dec 2000, 10(6) p514-23;

> discussion 524

>

> (2) http://www.pacificsurgery.com/index.html

>

> (3) Clare MW, " Equal Biliopancreatic and Alimentary Limbs: An

> Analysis of 106 Cases over 5 Years, " Obes Surg (England), Aug 1993, 3

> (3) p289-295

>

> p.p.s. Here is my guide to choosing a surgeon.

>

> -----------------------------------------------

>

> Many pre-ops are befuddled by the question of how to choose a

> surgeon. To help out, I've written down my thoughts on the process I

> went through to choose my surgeon. (Incidentally, my surgeon is Dr.

> Anthone at the University of Southern California.) I've also

> made sort of a form out of it. Feel free to use it as is, change it

> in anyway you like, give it away, etc.

>

> I hope you find this helpful.

>

> Tom LaRussa

>

> ---------------------------------------

>

> 1. MEDICAL SCHOOL ATTENDED: ________________________________________

>

> I look for docs who attended medical school either in the US or at a

> well-respected school in western Europe or Australia/New Zealand.

>

> Rationale: These are the best schools, and they therefore are

> hardest to get into, and thus get the best students. (An argument

> can be made for schools in former British Commonwealth countries, but

> none of the surgeons I looked at attended such a school, so I didn't

> have to deal with that issue.)

>

> 2. CHIEF RESIDENT?

>

> YES NO (circle one)

>

> I give preference to those surgeons who had been appointed as Chief

> Resident during their residencies.

>

> Rationale: Cream rises to the top. The chief resident is chosen by

> the faculty as the best among that resident group. I want the best

> working on me.

>

> 3. POST-RESIDENCY FELLOWSHIPS, ETC. ________________________________

>

> ______________________________________________________________________

>

> ______________________________________________________________________

>

> Rationale: Again, the cream rises to the top, so winning a

> competitive appointment to a post-residency fellowship is another big

> plus. In particular, I like to see a surgical fellowship after the

> residency because it indicates just that much more training and

> practice under the eye of experts.

>

> 4. PROFESSIONAL CREDENTIALS

>

> a. Is the surgeon certified by the American Board of Surgeons (or

> its British equivalent)? http://www.absurgery.org/home.html>

> (NOTE: This is an absolute requirement! If the answer is NO, go no

> further!)

>

> YES NO (circle one)

>

> Rationale: This is the basic, bottom line certification that

> says, " You are now a surgeon. "

>

> b. Is the surgeon a Fellow of the American College of Surgeons (or

> one of the Royal Colleges of Surgeons in Commonwealth countries)?

> http://www.facs.org/index.html>

>

> YES NO (circle one)

>

> Rationale: Membership in the ACS, (denoted by the initials F.A.C.S.

> after " MD " ), is voluntary, and requires recommendations from fellow

> members, plus what amounts to an investigation of the surgeon's

> practice history.

>

> c. Is the surgeon a member of the American Society of Bariatric

> Surgery?

>

> YES NO (circle one)

>

> Rationale: This is a professional/educational organization for

> bariatric surgeons. If a bariatric surgeon were not a member, I

> would certainly wonder why not. Don't they care about keeping up on

> new developments?

>

> 5. SURGICAL PRACTICE Comments: ______________________________________

>

> ______________________________________________________________________

>

> ______________________________________________________________________

>

> I prefer a surgeon who has practiced as a general surgeon for at

> least a few years before starting to do bariatric surgery.

>

> Rationale: I want a surgeon who is prepared to deal with any

> eventuality, both in the OR and in the post-op period. I figure that

> a few years practicing as a general surgeon gives them more exposure

> to all the different kinds of problems that can crop up.

>

> 6. BARIATRIC PRACTICE

>

> a. When, Where, and from Whom did they learn to perform the DS?

>

> ______________________________________________________________________

>

> ______________________________________________________________________

>

> Rationale: I don't want a surgeon who learned how to do the DS by

> watching a videotape. (NOTE: All of the DS surgeons I have ever

> looked closely at learned the surgery from someone quite qualified to

> teach it, so this isn't a big concern. On the other hand, this kind

> of thing does on all the time in cosmetic surgery, so it's not out of

> the question as more and more docs move into this field in the

> future.)

>

> b. How long has he/she been performing the DS? ______________________

>

> Rationale: I don't want to be one of their early DS patients, while

> they are still learning how to do the procedure really well.

>

> c. How many of his/her patients have died? When and under what

> circumstances?

>

> ______________________________________________________________________

>

> ______________________________________________________________________

>

> Rationale: If the doc is uncomfortable giving me this information, I

> would get worried about why he/she was uncomfortable.

>

> 7. RESEARCH AND OTHER STUDY OF OBESITY?

>

> YES NO (circle one)

>

> Comments: ____________________________________________________________

>

> ______________________________________________________________________

>

> I look at whether the surgeon has researched/studied the root causes

> of obesity, as well as whether the surgeon has studied the digestive

> tract in detail.

>

> Rationale: As much as possible, I'd like to have a surgeon who

> understands what obesity is all about, and WHY the surgery works (or

> does not work) and not just the technical aspects of how to

> perform our surgery.

>

> 8. AWARDS/OTHER

>

> ______________________________________________________________________

>

> ______________________________________________________________________

>

> I also give points if a surgeon has won awards for excellence, as

> well as any other signs that the surgeon works very hard to continue

> learning and improving as a surgeon.

>

> Rationale: Awards for excellence are, hopefully, further indicia of

> just that -- excellence. And, learning is a life-long process, not

> just something one does once.

>

> 9. ACCESSIBILITY

>

> ______________________________________________________________________

>

> ______________________________________________________________________

>

> Am I going to be able to get in touch with my doc in an emergency?

> Also, when I go to an appointment, with whom do I meet, the surgeon

> or some underling?

>

> Rationale: The world's best nurse hasn't been to medical school, let

> alone received advanced training in complex surgical techniques. I

> want to know that the person in whose hands I have placed my life

> with be there when I need him/her.

>

> 10. PERSONALITY

>

> ______________________________________________________________________

>

> Once I've found a truly excellent surgeon, it's time to consider

> whether I can get along with this person. Truthfully though, if the

> surgeon rated excellent in the categories above, I wouldn't reject

> her based on personality unless he were really an ogre or completely

> unapproachable.

>

> 11. OFFICE STAFF ___________________________________________________

>

> Is the staff at least minimally competent in doing what they do,

> i.e., pushing paper around and scheduling stuff.

>

> Rationale: I'm not entrusting my health and safety to the office

> staff, so who cares if they are morons and/or jerks as long as I get

> my appointments when I need them?

>

> ----------------------------------------------------------------------

>

July 4, 2001

Thanks Tom

I really appreciate your reply and I'm taking it all to heart and believe me the last thing I would do is pick a doctor because he/she is close to where I live...I have long been leaning toward Dr. Herron at Mt. Sinai but the experiences of the people he has performed surgery on is rather varied...that is to say that the doctor sounds just fine but I'm concerned about the hospital staff after and his staff in particular....My daughter just told me this is one of my famous run on sentences.... Anywho, thank you again and anyone who has dealt with Dr. Herron and his staff.....talk to me please. I'm getting more nervous as my consul gets closer...I'm still going to let the folks at the hospital know I'm coming but it's hard to get a clear picture of what to expect from this doctor and staff.

Cindy S

July 4, 2001

Marcia

Hello....I just called his office yesterday and spoke with his nurse...he is doing DS's now but after some thought...I can't imagine that he has done that many and I'm not gonna be a guinea pig for anybody...that is not to say that he is not a fine doctor, just that I would prefer someone of greater expertise. Makes sense to me...

Cindy S

July 5, 2001

Makes sense to me, too. You want to feel confidence in your surgeon and breath of experience is one of the criteria. I chose Dr. Ren of NYU ( yes, I know there is controversy there) because she trained with one of the best, Gagner of Mt. Sinai, was chosen to head NYU's program, have heard good things from former patients (except for one notable exception), but first and foremost, my Internist, with whom I would trust my life (which in fact I am doing by undergoing the DS) feels that she is the one for the job. Having met her, I feel he's right and will be putting my future in her hands on the 13th. Good luck to you in your journey down our common path.

Marcia

-----Original Message-----From: Cinloo59@... Sent: Wednesday, July 04, 2001 10:45 PMTo: duodenalswitch Subject: Re: St. 's University HospitalMarcia Hello....I just called his office yesterday and spoke with his nurse...he is doing DS's now but after some thought...I can't imagine that he has done that many and I'm not gonna be a guinea pig for anybody...that is not to say that he is not a fine doctor, just that I would prefer someone of greater expertise. Makes sense to me... Cindy S ----------------------------------------------------------------------

July 7, 2001

I will be thinking of you Marcia.....and all the best for a swift and uneventful surgery....

Cindy S

July 8, 2001

Thanks, Cindy. With less than a week to go, and no word that BC will honor my Cigna approval, I'm both scared and elated. Tomorrow will be lots of phone calls trying to pin SOMEONE down and then comes the countdown.

Marcia

-----Original Message-----From: Cinloo59@... Sent: Saturday, July 07, 2001 11:18 PMTo: duodenalswitch Subject: Re: St. 's University HospitalI will be thinking of you Marcia.....and all the best for a swift and uneventful surgery.... Cindy S ----------------------------------------------------------------------

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