Kay Bee sets a deadline -- read on if you have little else to do

[Guest guest]

Summary: " Kay Bee " posted a while back asking why folks have raised a

fuss about Dr. Ren's discontinuing to offer the DS, while nobody

seemed to be questioning Dr. Elariny's alleged steering of patients

away from the full DS and toward either a 2-step DS (Vertical

Gastrectomy, or " sleeve " as step 1, followed by the intestinal

re-routing, or " switch " after a loss of about 100 pounds) or the

sleeve alone. She also brought up an issue that implied that Dr.

Elariny was offering his sleeve-gastrectomy patients the option of

intentionally disabling the pylorus.

>From: kaybeekaybee@...

>Date: Tue Oct 30, 2001 5:11 pm

>Subject: The fallibility of surgeons

>...I am a firm believer in malabsorption as a means to permanent weight

>loss and therefore no fan of any purely restrictive surgery. Dr. Ren

>has taken heat on this list for advocating the Lap Band, but at least

>it offers enough restriction to do some good to the more moderately

>obese among us, it's adjustable, and its minimal invasiveness means

>that it will be undergone by those who otherwise would be unwilling

>to try any weight-loss surgery at all. I still doubt that it will

>prove to be the answer for a significant percentage of the morbidly

>obese. Dr. Elariny's stand-alone sleeve gastrectomy has come in for

>comparatively little criticism on this list, even though it tries to

>force the reduced stomach to carry the full burden of weight loss and

>maintenance, a function the BPD/DS's creator says it can't carry by

>itself. If we care that people who come to Drs. Ren and

>for the BPD/DS will now be offered only the BPD instead, we should

>care that Elariny is persuading increasing numbers of those who come

>to him for the BPD/DS to opt for the unadorned sleeve gastrectomy.

>Some of them (as I've seen on the Elariny list) even come away with

>the impression that the sleeve gastrectomy is " minor " surgery, which

>it is not. And if we care that the BPD leaves the patient without

>the pylorus, we should care that Elariny is reported on the DS-

>Elariny list to be offering his sleeve-gastrectomy patients the

>option of intentionally disabling the pylorus. If there has been any

>discussion of that on this list, I've missed it.

I not only disagreed with " Kay Bee's " implications, but questioned if

she was still engaging in legal action against Dr. Elariny. " Kay

Bee " denied that she was suing Dr. Elariny. I offered to retract the

accusation if my investigation proved me wrong. I have not had time

to complete a definitive investigation yet ,as I have been unable to

contact some of the parties who might have furnished my information

originally (they did not show up at the Elariny Support Group meeting

last night), but " Kay Bee " has thrown down the gauntlet (see first

forwarded message), threatening to post the details of our recent

private e-mail exchanges if I do not retract by 9:00 AM today, and

telling me, " Do yourself a favor, and do it yourself. " So, I will do

it myself, that is, post those correspondences as well as information

that I have been able to uncover to date. But, first, I'll summarize

what I have learned to date so that interested readers will not have

to wade through all the prior correspondence unless they wish to do

so.

I spoke to several new Elariny patients, both in his waiting room on

Monday and at the Support Group last night. I asked if they felt any

pressure to have the sleeve only. One woman who had the sleeve told

me that Dr. Elariny had suggested that the full DS would be

appropriate for her, but that she, herself, had insisted on the

sleeve only, and that is what she got. Others at the Support Group

meeting said that they felt no pressure from Dr. Elariny one way or

the other. In any event, it was clear that Dr. Elariny continues to

offer the full DS and does not steer patients to the 2-step procedure

on any wholesale basis.

I also had a LONG talk with Dr. Elariny at my exam on Monday. He had

to speak very carefully because of patient confidentiality issues,

and maybe some legal issues, too. For example, he told me that he

was " not aware that he is being sued AT THIS TIME. " He also

amplified on the one instance where he said that he might be willing

to disable the pylorus; it was a very special case, tailored to

specific needs of that patient (gastritis, vagotomy, refusal to have

malabsorptive procedure), and he wishes that people would not take

any one patient's information out of context to imply that this was a

general offering. (Further, at the Support Group meeting, in

response to a question from the floor, he told us that disabling of

the vagus nerves (vagotomy) and cutting open the pylorus to minimize

the time that food is held in the stomach is an accepted surgical

treatment for severe gastritis, quite independent of any WLS

considerations.) Similarly, he says that he also makes

recommendations about sleeve vs full DS on a case-by-case basis

(e.g., habitus, eating patterns, compliance outlook), and that, in

any event, these are recommendations with full disclosure to the

patient of the reasons and of the alternatives, and that, as long as

health is not endangered, he abides by the patient's wishes.

I believe this, because, for example, I have developed a fist-sized

hernia on my belly, and it will need eventual repair, and we

discussed at great length the full range of possible surgical

interventions including adjunct panniculectomy/abdominoplasty, and

cholecystectomy. We agreed to examine the full set of circumstances

(e.g., if I had any gall stones by then) after I lose another 25-30

pounds. We had previously discussed all the WLS possibilities when I

first presented for a consult back in April. So, my experience, at

least, is that Dr. Elariny does not intentionally steer patients in

any one direction, but instead assists them in making their own

choices with full disclosure.

I inquired about the alleged hanging up on " Kay Bee " during a phone

call from her about a 4-month --as I recall it-- overdue notice on a

bill that was sent to her for the first time. He told me that he was

out of town at a meeting when he received the call; that he made a

special effort to leave the meeting to speak to her; that he told her

not to worry about it, that it was a feature hard-coded into his

billing software, and that he was not reporting the bill for

collection or doing anything to hurt her credit rating (I have not

reproduced the separate mail thread that " Kay Bee " started on that

subject, but I was one of the people who answered, saying that I,

too, received a 90-day overdue notice on my first bill, but that Dr.

E. had forewarned me just to disregard the notice). He said that he

could not talk any longer with her, and that he had to get back to

his meeting. So, he had not refused to talk to her, and had made a

special effort to receive her call and to reassure her, and it was

not clear from what he was willing to tell me who hung up on whom in

that call.

I found a message from Kay Bee Too on

ObesityHelp.com

http://www.obesityhelp.com/morbidobesity/mdcomments.phtml?N=990946979:

10/04/01

Kay Bee Too

kbtoo0@...

Clinton, MD

Heads up, Elariny patients: going to this surgeon could be hazardous

to your credit rating. Yesterday, I received my first and only bill

from him--with the dunning notice that it was " >120 days past due " !

How can a FIRST bill be overdue on its arrival? I saw Elariny for a

BPD/DS consultation in December 2000; he did the pre-op work the

following January. We then parted. In July 2001, Elariny billed my

insurer for the consultation and pre-op procedures. Of course his

office sloppily coded the bills as " treatment for obesity, " and BCBS

turned them down flat. Elariny's office had not communicated with me

at all, and had not asked my assistance, but I wrote to BCBS on my

own initiative and the bills were paid in August. Elariny then

proceeded to bill BCBS again for the office visit and scopes for

which BCBS had just paid him, and when BCBS rejected the bills as

already paid, he dispatched to me his first and only bill for my

deductible (he isn't a BCBS preferred provider), with its bald

declaration that it is more than four months " overdue. " The bill

itself disproves its own claim of lateness, as it doesn't list any

prior billing activity. I just talked to Elariny on the phone, and he

defended the " overdue " notice on the ground that the insurance

company hadn't paid him promptly (why didn't he bill them promptly,

or properly?)--and then this prince among men hung up on me. So look

out: if you're planning on applying for a mortgage soon, think twice

about Elariny.

Was this the same " Kay Bee " ?

And, also, on the same web page, another one from " Miss CLF "

:

09/26/01

Miss CLF

missclf@...

WA, DC

WARNING, POSTERS TO THIS AND OTHER WLS WEB SITES: Elariny uses his

non-nurse assistant, Shauntae, to patrol the Web for unflattering

comments about him, and if she and he find some here or elsewhere and

attribute them to you, he will drop you as a patient. That's what

Elariny did in February 2001, after he says Shauntae found a post

describing how he'd waited until the night before my scheduled

surgery to read the report of the pre-op EKG I had taken eleven days

earlier, then called me up and told me that not only would I probably

not get to have the DS the next day, but I likely had the most

serious of heart problems. (He was dead wrong, as I learned the

following week from a heart specialist: my heart was in fine shape,

and had Elariny read the EKG in a timely manner, further tests could

have been done in time to save my original surgery date.) That the

post Shauntae brought him was true didn't stop Elariny from fuming at

a patient like a playground bully--nor from recommending that I see a

psychiatrist! (No, he had not previously referred me for a pre-op

psychiatric clearance.) Some Elariny groupies had the gall to suggest

that I was crazy to accuse this paragon of such treatment, but there

is evidence of what he did and of when he did it. About his surgical

prowess I can say nothing (though I am distressed by the approach he

has adopted toward the BPD/DS--see below). I can say that he did not

bother to show up at the hospital on what would have been the day of

my operation, when my surgery was canceled as I lay on the table;

that he made no effort to help me find a doctor to treat the alleged

" heart condition " he had found the night before; and that he made no

effort to help me find another surgeon after summarily directing me

to go elsewhere. Elariny's office is noisy and very disorganized, as

anyone who's been to a consultation with him can tell you. (The

office probably loses a lot of time to Shauntae's checking the

Internet for criticism.) Elariny confused my identity with that of at

least one other patient on the night before the scheduled surgery,

and his prolonged delay in dictating a report of a pre-op procedure

he did on me nearly cost me my surgery date with someone else. If you

are the old-fashioned type of patient who speaks to the doctor in a

tone of near-worship, you and Elariny should get along fine. If you

speak up for yourself--and especially if you care enough to tell

others researching this surgery what you have experienced--you risk

being dropped by this thin-skinned doctor, who uses the shortage of

surgeons who offer the BPD/DS as an excuse to display his immaturity.

One of his current patients notes on this page that Elariny purged

his surgeon's page (actually " moved " it to " Cut Off, LA, " after which

this page mysteriously appeared under the misspelled " Elarny " )

because of a patient's criticism. I'm very glad she included that

detail, as it proves my point about his thin skin. Of more concern to

me now than Elariny's vengefulness or his tinderbox temper is his

advocacy of the sleeve gastrectomy (the " top half " of the BPD/DS) as

a stand-alone procedure. Other BPD/DS surgeons do the BPD/DS in two

parts only on high-BMI or other high-risk patients, always with the

expectation of bringing them back for the intestinal portion after

they've lost enough weight to reduce the risks of anesthesia. Elariny

alone is pitching the " top half " to patients without high BMI's or

other unusual risks--and he is selling it to them with the pitch that

they might " learn good eating habits " with the smaller stomach and

therefore might never need the second half of the procedure. Trouble

is, the restriction-only approach has already been tried, and has

failed more often than not, with the old stomach-staplings and the

vertically-banded gastroplasty. Patients who fall for Elariny's line

have much less than an even chance of getting and keeping all their

weight off. In the most egregious case that I know of, Elariny did a

" top-only " on a woman who'd been scheduled for the full BPD/DS

because his previous surgery that day ran overlong. I can see only

one likely winner from Elariny's experiment: Elariny, who will

collect two surgeon's fees for what should have been one procedure.

Could this also be our " Kay Bee " ? Story is awfully similar to that

posted by " Kay Bee, " but no definitive proof that it is one and the

same person.

Finally, I attempted to contact people whom I recalled were present

when I had first heard that " Kay Bee " posted under a different name

on a different list and was suing Dr. Elariny. Here is the one

response that I received (names have been omitted:

> > [Original Message]

>>

> > To: <name supressed>

> > Date: 11/5/01 10:31:37 AM

> > Subject: KayBee

>>

>> Did I make a mistake? Wasn't it KayBeeKayBee that you warned me was

>> suing Dr. Elariny? If you have a minute, please call me at my office.

> Thanks. --Steve

>

>From: <name supressed>

>To: " Steve Goldstein "

>Subject: RE: KayBee

>Date: Mon, 5 Nov 2001 15:34:36 -0500

>

>Yes, she is the same person.

>I had asked Dr. E about her, once months and months ago. He told me he was

>not allowed to talk about her and what had happened. I asked him if he was

>not talking about her to me, for fear that I knew her? He said no, that he

>was not allowed to talk about it, period. I said to <name

>suppressed>...wonder if Doc E is suing her..she said no, Kay is

>suing Doc E..that he was served with papers the day before,

>while she was at the office. (this was months ago, maybe June or July)

Bottom line: I still have not been able to uncover definitive proof

that " Kay Bee " ever did sue, or is currently suing, Dr. Elariny or

that she posts, or had posted, under a different e-mail name

elsewhere. So, I must retract those assertion with apologies to

" Kay Bee. " But, given the threat of " disclosure, " I wanted to be the

first party to disclose the relevant correspondence.

What is very clear is that I admire, respect, and, indeed have

trusted my life to Dr. Elariny, and that " Kay Bee " and that " Kay Bee

Too " and " Miss CLF " , whoever they may be, feel quite differently

about him.

--Steve

Now for the postings. We'll start with the latest posts and work backwards:

=============== BEGIN FORWARDED MESSAGE ===============

>X-Originating-IP: [198.246.67.60]

>

>To: steve-goldstein@...

>Subject: Re: The fallibility of WLS patients

>Date: Tue, 06 Nov 2001 17:06:30 -0500

>X-OriginalArrivalTime: 06 Nov 2001 22:06:30.0832 (UTC)

>FILETIME=[4A17AB00:01C1670F]

>

>

>

>If you have not put a retraction on the DS list by 9 a.m. tomorrow,

>I will put all the details of our recent correspondence into a post

>for the entire list.

>

>Do yourself a favor, and do it yourself.

>

================ END FORWARDED MESSAGE ===============

=============== BEGIN FORWARDED MESSAGE ===============

X-Originating-IP: [198.246.67.60]

To: steve-goldstein@...

Subject: Re: The fallibility of WLS patients

Date: Mon, 05 Nov 2001 11:03:46 -0500

X-OriginalArrivalTime: 05 Nov 2001 16:03:47.0051 (UTC)

FILETIME=[73747BB0:01C16613]

Steve:

Someone passed along to you a rumor that I was posting to a different

e-mail list, under a different name. The identity of that person you

can no longer recall.

You cannot recall to which list I am allegedly posting.

You cannot recall under which name I am allegedly posting.

You did not see the posting.

You do not know how the person who passed along the rumor that I was

suing a DS surgeon acquired the information.

Yet you saw fit to report that rumor as fact on an e-mail list read

by more than 1500 people--and yes, you did report it as fact, because

you didn't ask me whether I had a lawsuit against Elariny. You asked

me if I was " still " pursuing one.

I am sure this posting led its readers to conclude that I have some

financial interest in writing what you characterize as " negative "

posts about Elariny. In their place, that's what I would conclude.

Yes, I think you should retract this statement on the DS list, and I

think you should report that you made the statement as the result of

a rumor.

Don't you?

Kay B.

================ END FORWARDED MESSAGE ===============

--

=============== BEGIN FORWARDED MESSAGE ===============

X-Sender: steve-goldstein@... (Unverified)

Date: Mon, 5 Nov 2001 10:23:14 -0500

To: " Kay Bee "

Subject: Re: The fallibility of WLS patients

>Steve:

>

>You wrote:

>

>In a group discussion, I had heard that you post on a different mail

>list (OSSG?) under a different e-mail name and that you sere suing

>Dr. E. The implication is that this was the reason that he would

>not speak to you on the phone. Was i misinformed?

>

>Okay, I'm counting to ten. No, this requires a count of at least

>twenty. Now, then:

>

>What " group discussion " was this?

Informal group in real time, not on line.

>

>Why am I the subject of a " group discussion " ?

Your negative posts regarding Dr. E.

>

>Who is it that purports to know that I am " posting on a different

>mail list...under a different e-mail name " ?

I can no longer recall.

>

>Which list? Which name?

I cannot recall.

>Did you see this posting?

No.

>

>How did this person get this " information " ?

Don't know. I suspect that the person also read that mail list.

>

>I have some more questions for you, but I want to see answers to

>these first. Please write back soon!

>

>Kay B.

>

>By the way, I have never written that Elariny refused to talk with

>me. Sorry to disappoint the " group " ...

Did you not write, about 1-2 months ago, that when you called him, he

refused to talk with you? Or, am I losing my marbles completely.

( " Old Timers' Disease " may be closing in faster than I had

anticipated.)

--Steve

--

================ END FORWARDED MESSAGE ===============

=============== BEGIN FORWARDED MESSAGE ===============

X-Originating-IP: [198.246.67.60]

To: Steve-Goldstein@...

Subject: The fallibility of WLS patients

Date: Mon, 05 Nov 2001 09:34:25 -0500

X-OriginalArrivalTime: 05 Nov 2001 14:34:25.0619 (UTC)

FILETIME=[F7CAE230:01C16606]

Steve:

You wrote:

In a group discussion, I had heard that you post on a different mail

list (OSSG?) under a different e-mail name and that you sere suing

Dr. E. The implication is that this was the reason that he would not

speak to you on the phone. Was i misinformed?

Okay, I'm counting to ten. No, this requires a count of at least

twenty. Now, then:

What " group discussion " was this?

Why am I the subject of a " group discussion " ?

Who is it that purports to know that I am " posting on a different

mail list...under a different e-mail name " ?

Which list? Which name?

Did you see this posting?

How did this person get this " information " ?

I have some more questions for you, but I want to see answers to

these first. Please write back soon!

Kay B.

By the way, I have never written that Elariny refused to talk with

me. Sorry to disappoint the " group " ...

>From Steve-Goldstein@... Sat, 03 Nov 2001 07:22:35 -0800

Received: from [24.93.67.54] by hotmail.com (3.2) with ESMTP id

MHotMailBDAD569C0040400431E2185D433612F30; Sat, 03 Nov 2001 07:22:04

-0800

Received: from [192.168.0.2] ([66.61.189.42]) by

mail7.mgfairfax.rr.com with Microsoft SMTPSVC(5.5.1877.687.68);

Sat, 3 Nov 2001 10:22:03 -0500

Mime-Version: 1.0

X-Sender: Steve-Goldstein@...

Message-Id: <p0510030ab809b752ef89@[192.168.0.2]>

In-Reply-To: <9rv593+4h09 (AT) eGroups (DOT) com>

References: <9rv593+4h09 (AT) eGroups (DOT) com>

Date: Sat, 3 Nov 2001 10:21:56 -0500

To: kaybeekaybee@...

Subject: Re: The fallibility of surgeons - Steve

Content-Type: text/html; charset= " us-ascii "

Return-Path: Steve-Goldstein@...

>First of all, I didn't say that Elariny isn't doing the BPD/DS

>anymore. I said that he's encouraging many people who come to him

>for that procedure to have the stand-alone sleeve gastrectomy

>instead, which I have reason to believe to be true.

I'll ask him about this.

>

>

>

>> Dr. Elariny is cautious about doing the entire DS in one procedure

>in

>> super morbidly obese patients because of the risks...

>

>I was not super-morbidly obese, but he pitched the sleeve gastrectomy

>to me on the night before I was to have surgery, as I have said, and

>when I said that I did not want " surgery in two acts, " he said I

>might never need the second part. He has also so advised others, as

>reported on the DS-Elariny list and elsewhere. This is what sets

>Elariny apart from other surgeons who do the DS in two parts: only

>Elariny suggests that the stomach-only portion should be enough for

>some people.

I vaguely recall his having said something about [over]eating style.

The point was that if the person simply eats huge quantities, but

only three meals a day with no snacking and no sweets, then the

sleeve might suffice. But, if the person generally does not eat

large portions and/or grazes all day, then the malabsorptive addition

is indicated. Makes sense to me.

>

>> I am not aware that Dr. E. has offered anybody the option of

>> intentionally disabling the pylorus.

>>

>That's what I take from the " Sleeve Gastrectomy/Cinda " postings on

>the DS-Elariny list on 9/20/01 and 9/25/01, including one from you,

>Steve. You advised people against having the pylorus disabled.

OK, I went back and looked at the messages. The key:

Hi,

I am also thinking about having the verticle gastrectomy (sleeve) of

the switch. He can also do something with the pilori valve so that

sweets make me dump. If anyone else has had the banding or vg please

let me know how you are doing now.

and, my answer:

You REALLY don't want to do that!!! The pylorus is wayyyyyy too

important to disable it. It regulates the flow of partially digested

food from the stomach into what will be left of your intestine. If

it is disabled, sure it dumps. But, it dumps everything, not just

sugar. Don't do it. But, if you insist on doing it, you might as

well get the RnY and not the DS.

Well, now I see what you are writing about. Sorry. I totally forgot

about that. My best guess is that the person wanted dumping as a

regulator of sweets intake, and Dr. E. apparently said that he could

do the sleeve and also disable the pylorus, if the patient wanted

that done. It did not appear that Dr. E. actually advocated doing

that, however. Dr. E's approach seems to be to give the customer

what he/she wants, as long as the customer is informed and as long as

the procedure would not present major health risks. And, yes, I

counseled against disabling the pylorus and still stand by my counsel.

>

>

>> Kay, do you still have legal proceedings underway against Dr.

>Elariny?

>>

>

> " Still have legal proceedings underway " against Elariny?! It's news

>to me that I ever did.

In a group discussion, I had heard that you post on a different mail

list (OSSG?) under a different e-mail name and that you sere suing

Dr. E. The implication is that this was the reason that he would not

speak to you on the phone. Was i misinformed?

>As a lawyer, forced to wade through other

>people's disputes daily, I'm probably less inclined to file lawsuits

>than many non-attorneys are.

Well, that's refreshing! If I am wrong, please advise me and accept

my apologies. I will be happy to let the list know that I was

misinformed, if you would like.

>

>Please e-mail me about this privately, Steve.

Thanks for taking it private, Kay.

--Steve

BTW, if you want to call me at work (I get in before 7AM because of

the HOV restrictions on Route 66) I am at <number deleted>.

>

>Kay B.

>

--

================ END FORWARDED MESSAGE ===============

=============== BEGIN FORWARDED MESSAGE ===============

From: kaybeekaybee@...

Date: Tue Oct 30, 2001 5:11 pm

Subject: The fallibility of surgeons

This will be a long-winded post, because I've had two DS surgeons,

both of whom have generated some controversy.

I've been bemused in recent months to see that both the surgeons with

whom I signed up for the operationñHazem Elariny and

Renñhave proved to be less than committed to the BPD/DS. They're

both young surgeons who are still carving out identities for their

practices. Elariny seems uncomfortable with malabsorption as a means

to weight loss, as he is persuading more and more of those who come

to him for the BPD/DS to opt for Elariny's stand-alone sleeve

gastrectomy instead. Ren has become a proponent of the Lap Band

since the FDA approved that procedure recently. I thought that meant

that she too was beginning to prefer purely restrictive procedures to

malabsorptive ones, until the recent news that she's embracing the

BPD without the DS.

Many people have asked me how I came to switch from Elariny to Ren.

Last winter, on the night before my scheduled BPD/DS, Elariny called

me at home to tell me that he had just reviewed the pre-op tests I

had taken nearly two weeks earlier. Though I had no history of heart

trouble, the EKG disclosed that I was a possible candidate for open-

heart surgery, he said. While I was still recovering from the shock

of this, Elariny went on that if by chance I got to have my operation

the next day, I'd have to agree to have it open, rather than lap,

because of adhesions. (I had had one previous abdominal surgery, so

I didn't realize until later in the conversation that he'd confused

me with a patient who'd had three Caesarean sections.) If I insisted

on having it done lap, Elariny said, I'd have to be willing to wake

up with " just the top " of the operation doneñwhich was my

introduction to Elariny's stand-alone sleeve gastrectomy. He tried

to sell it to me as a " superior " operation to the DS, but I was in no

shape to process the information.

Having received lots of sweet e-mails from fellow members of AMOS

wishing me well, I thought it was only fair that I let them know that

my surgery was canceled the next day as I lay on the table (Elariny

did not show up at the hospital, choosing to deal with the

anesthesiologist and the cardiologist by phone instead). It was

the " surgery canceled " post to AMOS that brought about my parting

from Elariny. He didn't appreciate my telling other pre-ops that he

had waited until the night before my surgery to review the pre-op

tests, and told me to find myself another surgeon. (He had also, by

the way, left me on my own, without map, suggestion, or referral, to

figure out whether in fact I had a heart problem. A stress test by a

cardiologist found no abnormality and cleared me for surgery, meaning

that had Elariny looked at my tests even a few days earlier, my

operation could have proceeded on schedule.)

What continues to baffle me is the reaction of my fellow Elariny

patients to my news about Elariny. Many of the same people who had

embraced me so warmly before, with the empathy that is so evident on

this list and others, now attacked meñthere's no other word for

itñfor saying such mean things about their savior. Elariny

couldn't have acted like that, spoken like that; I must be a liar, I

must be crazy. I was called a psycho on more than one Internet

site. A member of this list with whom I had commiserated in a

private e-mail used the matter as an excuse to betray a confidence.

And then there were those who lined up to " take credit " for blowing

the whistle on me. Each Elariny loyalist was serenely certain that

it was her exposure of the " incriminating " Internet posting that had

put me out on the street to find another surgeon. I suppose they all

must have wanted me to post their names publicly, so that they could

win the applause of their fellow Elariny devotees. I denied them the

publicity; I didn't even respond to their e-mails. I simply deleted

their messages and blocked their addresses.

This surgery is no mere operation; it's the Holy Grail. Between the

night of Elariny's dire pronouncement and the day I was cleared for

surgery, I daydreamed about digging my " defective " heart out of my

chest with a dull knife (if it was keeping me from having the

surgery, I wanted to be rid of it). How could anyone believe that I

had just " made up " a set of circumstances that caused me to have to

start this emotionally draining process all over again?

I was ready to go to Dr. Baltasar in Spain on a raft if I had to,

rather than get in line for another U.S. surgeon. Dr. Ren's office

penciled me in immediately, and for that and much more I am and will

remain grateful to her. Some will say I should I have waited for a

more experienced surgeon, and maybe they're right; but at that point,

waiting was intolerable. To those who poo-poo the importance of

bedside manner, I must say that the warmth and empathy that my family

and I found in her was therapy in itself, a huge factor in getting us

all to and through the surgery. And the BPD/DS she performed on me

would appear at this point to be flawless. At nearly eight months

post-op, I have had no pains, no gastrointestinal distress, no

vitamin or mineral deficiencies, no problems of any sort, and my

weight loss is proceeding on schedule.

Deb Mullen's surgery with Dr. Ren preceded mine, but I heard nothing

of her difficulties until well afterward. I'm not qualified to say

whether what happened during Deb's surgery was inevitable due to

Deb's anatomy, was the product of the surgeon's inexperience, or was

some combination of the two. I don't need to know the answer to that

to empathize with Deb's pain and feelings of betrayal and violation.

That my experience with Dr. Ren was almost the antithesis of Deb's

never led me to believe that Deb must be deluded, dishonest, or in

need of psychiatric care. I will never say that Dr. Ren " couldn't "

have made the statements Deb attributes to her, even though they were

so different from what Dr. Ren has said to me. Deb still has my best

wishes; Dr. Ren still has my gratitude.

I am a firm believer in malabsorption as a means to permanent weight

loss and therefore no fan of any purely restrictive surgery. Dr. Ren

has taken heat on this list for advocating the Lap Band, but at least

it offers enough restriction to do some good to the more moderately

obese among us, it's adjustable, and its minimal invasiveness means

that it will be undergone by those who otherwise would be unwilling

to try any weight-loss surgery at all. I still doubt that it will

prove to be the answer for a significant percentage of the morbidly

obese. Dr. Elariny's stand-alone sleeve gastrectomy has come in for

comparatively little criticism on this list, even though it tries to

force the reduced stomach to carry the full burden of weight loss and

maintenance, a function the BPD/DS's creator says it can't carry by

itself. If we care that people who come to Drs. Ren and

for the BPD/DS will now be offered only the BPD instead, we should

care that Elariny is persuading increasing numbers of those who come

to him for the BPD/DS to opt for the unadorned sleeve gastrectomy.

Some of them (as I've seen on the Elariny list) even come away with

the impression that the sleeve gastrectomy is " minor " surgery, which

it is not. And if we care that the BPD leaves the patient without

the pylorus, we should care that Elariny is reported on the DS-

Elariny list to be offering his sleeve-gastrectomy patients the

option of intentionally disabling the pylorus. If there has been any

discussion of that on this list, I've missed it.

Meanwhile, I'm loving malabsorption. It has set me free: free from

stuffing myself beyond satiation today because I must begin the diet-

to-end-all-diets tomorrow. No more dieting for me. I love the

feeling of being satisfied with little food. I love being able to

stop with " just one " of a sweet treat without feeling deprived.

I feel smug when a package of cookies or candy lasts for weeks or

just goes unopened. At eight months out, I've lost more than sixty

percent of my excess weight. Bones are bursting out all over me.

And I'm glorying in the unfamiliar lingering glances of men.

================ END FORWARDED MESSAGE ===============

[Guest guest]

Steve,

Holy Sh*t, I don't think anyone has enough time in the day to read

that whole spiel!! I'd still be reading instead of having surgery

tomorrow!! From what I read though, I have no doubts that Dr E is

completely informing his patients of their options and tailoring

options for his specific patients, such as Dr Keshishian only doing

the sleeve gastrectomy for TiaNeeNee because they both had concerns

about the malabsorptive portion if TiaNeeNee's MS worsened.

Anita

Surgery date 11/08/01

> Summary: " Kay Bee " posted a while back asking why folks have raised

a

> fuss about Dr. Ren's discontinuing to offer the DS, while nobody

> seemed to be questioning Dr. Elariny's alleged steering of patients

> away from the full DS and toward either a 2-step DS (Vertical

> Gastrectomy, or " sleeve " as step 1, followed by the intestinal

> re-routing, or " switch " after a loss of about 100 pounds) or the

> sleeve alone. She also brought up an issue that implied that Dr.

> Elariny was offering his sleeve-gastrectomy patients the option of

> intentionally disabling the pylorus.

> > ================ END FORWARDED MESSAGE ===============