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Judy, I know what you mean about playing russian roulette with your life. I

definitely experienced the same feelings before surgery, However, being obese

is another way of gambling your life away, and in the end you will most

likely crap out. I decided that in my case, the risk of surgery was less than

the risk of continuing to gain more weight. I know where you're coming from

and how you feel. If you have any questions feel free to ask. Good luck with

your research.

Kim

Dr. Anthone

DGB/DS-open 4/18/01

-64lbs

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> I still cannot shake the feeling that it is

> almost like playing russian roulette. Who will

> have complications, botched surgery and death.

I think that comparing surgery to Russian Roulette is a pretty broad

overstatement, (and I should know, as I was named the " King of Purple

Prose " in school).

IN MY OPINION, " complications, botched surgery and death " do

not " just happen " in a vacuum. Sure, to some extent, complications

and death can result from factors beyond anyone's control, such as

the weight and/or health of the patient prior to surgery, the natural

strength (or lack thereof) of the patient's immune system, and a lot

of other things.

But, to a large extent, I THINK that you can control your chance of

" complications, botched surgery and death, " (particularly " botched

surgery), by choosing your surgeon very carefully.

> I now assume people just don't want to hear

> about the bad. As someone reasearching this,

> I want to hear everything, good and most

> importantly bad.

OPINION ALERT -- OPINION ALERT!

I think it's true that some people just don't want to hear the bad,

but I think that's a fairly small proportion of folks. What is more

common is for people to defend their own surgeon blindly. Some do

this out of a sense of loyalty/debt, i.e., he saved my life, so he

must be good. Others seem to defend their surgeons out of a fear of

embarassment, i.e., if something bad is true about my surgeon, then

I'll be publicly embarassed for having chosen him/her.

END OPINION ALERT

> I am still on the fence about wls. I don't

> want to be the statisic that has had problems

> or worse, death.

I fully understand. I sat on the fence about WLS for about ten

years. During those ten years I went from about 260 pounds to 386 on

the day of my surgical consultation. Moral: Don't sit on the fence

too long, or you might get some really bad splinters when it

collapses under your weight.

> On the other hand, I am type 2 diabetic and I know

> that will lead to a shortened life span in time.

Yep. Sure will. On the other hand, the DS will almost assuredly

CURE your diabetes.

From Dr. Ren's letter:

> I have performed 38 lap BPD/DS, one was converted

> to open. Noone died on the table. During my fellowship,

> one died 6 months after surgery from sepsis from a

> leak, one died 10 days later from respiratory problems.

So, out of 38 procedures, we have 2 dead (plus Deb). That's a death

rate of 5.26%. IN MY OPINION, that is not a very promising start.

Compare that to Dr. Hess, who had a total of six deaths among his

first 440 patients, for a death rate of 1.36%. In other words, Dr.

Ren's death rate is more than 3.86 times as high as Dr. Hess' death

rate. And Dr. Hess CREATED the BPD/DS operation, so his first 440

patients were the first 440 BPD/DS's ever performed!

But Dr. Hess only performs open, so perhaps it would be more proper

to compare Dr. Ren's experience to that of Dr. Rabkin? Well, Dr.

Rabkin reports that he had ZERO deaths among his first 185 LAP

patients.

So, am I saying that Dr. Ren is a bad surgeon? No, just

inexperienced compared to Dr. Hess and Dr. Rabkin, (as well as many

other DS surgeons).

Dr. Hess, for example, finished his surgical residency sometime

around 1965, and did not begin performing the DS until about 1990.

In the meantime, he picked up 25 YEARS of surgical experience.

Dr. Rabkin finished his surgical residency about 1977, but did not

begin performing the Lap DS until about 1999. Prior to that, he had

20 years experience performing bariatric surgery, 8 years experience

performing the DS by open, and 10 years experience in other

laparoscopic surgeries.

So, is the DS really like Russian Roulette?

One day I was talking to my surgeon, Dr. Anthone, and I asked him how

a surgeon learned to use his fingers with such dexterity.

(Incidentally, Dr. Anthone finished his post-residency surgical

fellowship in 1991, started performing the DS in 1997, and has had a

total of three patient deaths, with none in the past four years.)

Dr. Anthone replied that just about any reasonably intelligent person

could be taught surgical technique -- cutting, suturing, tying knots

one-handed, etc. But what makes a good surgeon is the ability to

make good decisions under tough circumstances. Developing this

ability, he explained, takes much longer than learning surgical

technique.

I think that all pre-ops can take a lesson from what Dr. Anthone told

me. The lesson is, be sure to take the time and effort to learn

enough about the DS to make a good decision on which doctor (among

those that are available to you financially, etc.) is the best

surgeon.

Good luck,

Tom

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