PLEASE DO NOT COPY OR REPEAT ANY OF THIS POST - this is just for HERE.
As I mentioned on the thread about Dr. Gagner's conference and trying to get anecdotal evidence, I have been participating in a long thread on LinkedIn, on an ASMBS group which is mostly but by no means exclusively comprised of surgeons. Tammy Simmon is in the group, for example, as is Alex Brecher (Tammy is a DSer who offers her "services" in helping people get insurance approval - her LinkedIn job title is "Medical Assistant and Owner at Center for Bariatric Advocacy and Support" - the latter being her company; Alex is the owner of BariatricPal.com).
This discussion started with a question about whether a patient with a BMI of 68 who was given a sleeve, got down to a BMI of 38 and got stuck and started to regain, should be reoperated, and if so, with which procedure. Gagner and I got involved in the discussion (noted with approval by several others), in particular in rebuttal of the false assertions that the DS is too dangerous, and the thread took off.
Also in particular, I offered my opinion about poor advice given by surgeons about nutritional needs of their patients as being a primary cause of poor outcomes with the DS (and other surgeries as well). Apparently, Gagner and I pissed off Dr. Jesus Arturo Armento Jasso of Neuvo Laredo MX - he has been fiercely and not very nicely rebutting what we have said.
This morning, I found THIS in my email, via a PM from Armento Jasso (funny - his LinkedIn profile is limited to his first name, but includes where he works - it took about 2 seconds to figure out his last name). Since he addressed me as Diana in this piece of shit PM, my response is directed to Jesus:
To which I responded
I hope that sits his ass down.
As I mentioned on the thread about Dr. Gagner's conference and trying to get anecdotal evidence, I have been participating in a long thread on LinkedIn, on an ASMBS group which is mostly but by no means exclusively comprised of surgeons. Tammy Simmon is in the group, for example, as is Alex Brecher (Tammy is a DSer who offers her "services" in helping people get insurance approval - her LinkedIn job title is "Medical Assistant and Owner at Center for Bariatric Advocacy and Support" - the latter being her company; Alex is the owner of BariatricPal.com).
This discussion started with a question about whether a patient with a BMI of 68 who was given a sleeve, got down to a BMI of 38 and got stuck and started to regain, should be reoperated, and if so, with which procedure. Gagner and I got involved in the discussion (noted with approval by several others), in particular in rebuttal of the false assertions that the DS is too dangerous, and the thread took off.
Also in particular, I offered my opinion about poor advice given by surgeons about nutritional needs of their patients as being a primary cause of poor outcomes with the DS (and other surgeries as well). Apparently, Gagner and I pissed off Dr. Jesus Arturo Armento Jasso of Neuvo Laredo MX - he has been fiercely and not very nicely rebutting what we have said.
This morning, I found THIS in my email, via a PM from Armento Jasso (funny - his LinkedIn profile is limited to his first name, but includes where he works - it took about 2 seconds to figure out his last name). Since he addressed me as Diana in this piece of shit PM, my response is directed to Jesus:
On 02/01/15 9:47 AM, Jesús Arturo A. wrote:
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Hi Diana . It´s curious that somebody that never has been in a OR , or has been face to face wit a complicared patient could have the courage to read two or three medical articles and give an opinion.
It´s shameful that you gave a recommendation of how to face a medical problem to a surgeon that has 20 years doing what is the best for his patients.
The problems with patents are PAPER problems and are not a matter of life or death.
I prefer to have a mistake by conviction and not by fashion or imitation.
Dr Gagner is one of the geatest surgeons of this time, but in a meeting debates is not the only that has the truth in his hands.There are a lot of surgeons in the world that differs with him.
The miinformation in people like you is what kill patients not our work. I have more than 200 hundred bariatric surgeries with no one death.
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Hi Diana . It´s curious that somebody that never has been in a OR , or has been face to face wit a complicared patient could have the courage to read two or three medical articles and give an opinion.
It´s shameful that you gave a recommendation of how to face a medical problem to a surgeon that has 20 years doing what is the best for his patients.
The problems with patents are PAPER problems and are not a matter of life or death.
I prefer to have a mistake by conviction and not by fashion or imitation.
Dr Gagner is one of the geatest surgeons of this time, but in a meeting debates is not the only that has the truth in his hands.There are a lot of surgeons in the world that differs with him.
The miinformation in people like you is what kill patients not our work. I have more than 200 hundred bariatric surgeries with no one death.
To which I responded
I beg your pardon Jesus - in case you have not read what I wrote carefully, I have a PhD in medical biochemistry and molecular biology from UCLA Medical School; I have been researching, reading and compiling a library of scientific literature in the bariatric field for my own knowledge and for my pro bono work helping patients overcome inappropriate and self-serving insurance denials of the DS for 10 years, which pro bono work I do in conjunction with a retired surgeon (our appeal success rate is about 95%, and we have forced changes in medical policies for insurance companies operating in California, as well as helped to change Medicare coverage for the DS); and I am well-trained, well-read and comprehend bleeding edge scientific literature as well or better than most surgeons, due to my daily work in the biotech patent field. I don't rely on courage or lack of ethics, as you suggest, to speak out - I rely on my knowledge and scientific training, and I am hardly the dilettante you suggest.
I think it is shameful for bariatric surgeons to ignore the real-life experiences of hundreds of patients, many with medical and scientific training, when they say the advice being given by their surgeons, most of whom don't have specific nutritional training (because there is hardly any clinical-trials based evidence) in the long-term effects of bariatric surgery, much less what the patients are experiencing, IS NOT working, but the advice they are getting from people successfully living and thriving with the surgeries (documented by lab results) who are telling them differently, IS working. I am on bariatric message boards every single day, reading about and talking with hundreds if not thousands of patients, so I am not just talking about my OWN experience. And I have been "face-to-face" (online and in real life) with plenty of patients with complications struggling to overcome issues that their own surgeons don't know often can be fixed with simple things like a round of metronidazole followed by high quality probiotics including S. boulardii; avoiding foods with retrograded starch and sugar alcohols; getting iron infusions, taking higher quality supplements, or testing for and adding copper if deficient (many if not most surgeons don't test for copper and ceruloplasmin). These are very REAL pieces of empirical evidence, as real or more than the brief face-to-face encounters with your few patients in your office.
I am not suggesting that we veteran patients know everything, but I AM suggesting that our experience is that the surgeons often give out ignorant and dangerous advice, while we patients are by necessity developing a wealth of anecdotal experience and expertise that at the very least should be considered, and optimally, should be tested by proper clinical trials. This is particularly shameful when we have patients who get into trouble and are ignored, blamed for non-compliance (with the incorrect advice they have received), get even sicker, and when they in desperation follow the advice of other patients who have gone before them (and we urge them to get their doctors to accept the challenge, and to prescribe as necessary), they almost always get well. Please take a look at this story - just the most recent example of which I am aware: http://bariatricfacts.org/threads/razbrys-journey-a-cautionary-tale.2446/
My understanding is that the purpose of Dr. Gagner's conference (http://www.ifso.com/ifso-endorsed-meetings/), based on what he told me (and I assume it is OK for me to share this with you):
"It is principally for surgeons, the agenda will include one day of live surgery (very technical) and a second day of presentations about results, outcomes, management of complications, including nutritional. This will be a small conference, about 250 participants, and we do not have a lot of industry support at the moment. It will be a consensus conference, meaning that the top surgeons in the World are invited to vote and publish a consensus statement later. There is an increasing interest Worldwide, and from younger surgeons, to learn from this operation. We want to send the proper and right messages about the DS, and get rid of unscientific statements circulating."
I don't fully understand what you intended by your seemingly negative comment about him, perhaps due to your limitations in English (fair enough - I can order cerveza in Spanish, but that's about it), but what I think I did understand is that you think other surgeons' opinions (including the majority who do not perform the DS) make his opinion in some way per se questionable. Your finger-wagging should be done in front of a mirror.
As for your comment at the end of your email, in my experience, surgeons who have not one death are often cherry-picking their patients, and therefore not helping the ones in most need. And with all due respect, assuming only 200 lower risk (and lower efficacy, long run) surgeries on low risk patients, this number is not statistically impressive to me. How many of your patients are 10 years out and still healthy, successful (>50% EWL), free of comorbidities and report excellent quality of life? Those are numbers that impress me. I daresay the numbers for DSers, and in particular those who have received adequate nutritional advice, are superior to the numbers for other, less effective surgeries.
And while I think it is important to pre-operatively weed out patients who are not capable of being compliant with the minimal requirements of properly managing a DS (I would not be averse to both psych AND IQ tests), I am certain that the vast majority of problems that DSers experience are due to their surgeons' and treating physicians' lack of knowledge about long-term DS nutritional requirements, not lack of patient compliance or intractable defects in the surgery itself (aside from optimization of surgical parameters based on the patient's needs, but that's a different issue). I firmly believe that properly formulated clinical trials to test the results of the patients' empirical evidence of what DOES work would show this, and concomitantly provide even better evidence of the superiority and safety of the DS.
Moreover, I submit that misinformation in the form of denigrating a superior surgery because the surgeon doesn't understand it, can't perform it competently, and/or by failure to even disclose it at all (and thus not providing the patient with the opportunity to give fully informed consent), is also unethical and constitutes malpractice. In response to your outrageous assertion that "The miinformation in people like you is what kill patients," I challenge you to provide evidence of one single incident where information from "people like me" - by which I assume you mean intelligent, informed patients who disagree with inadequate nutritional advice from a surgeon - has killed anyone.
I respect your opinion, and have tried to keep my comments professional, but note that your comments come across as hyperbolic, arrogant, dismissive and baiting. I urge you to LISTEN to well-informed patients and DS surgeons with an open mind and with a mental filter that does not automatically exclude information that is inconsistent with what you think you know. And if you don't like what I'm saying, please consider ignoring me, rather than resorting to ad hominem attacks on my knowledge and ethics.
I am not suggesting that we veteran patients know everything, but I AM suggesting that our experience is that the surgeons often give out ignorant and dangerous advice, while we patients are by necessity developing a wealth of anecdotal experience and expertise that at the very least should be considered, and optimally, should be tested by proper clinical trials. This is particularly shameful when we have patients who get into trouble and are ignored, blamed for non-compliance (with the incorrect advice they have received), get even sicker, and when they in desperation follow the advice of other patients who have gone before them (and we urge them to get their doctors to accept the challenge, and to prescribe as necessary), they almost always get well. Please take a look at this story - just the most recent example of which I am aware: http://bariatricfacts.org/threads/razbrys-journey-a-cautionary-tale.2446/
My understanding is that the purpose of Dr. Gagner's conference (http://www.ifso.com/ifso-endorsed-meetings/), based on what he told me (and I assume it is OK for me to share this with you):
"It is principally for surgeons, the agenda will include one day of live surgery (very technical) and a second day of presentations about results, outcomes, management of complications, including nutritional. This will be a small conference, about 250 participants, and we do not have a lot of industry support at the moment. It will be a consensus conference, meaning that the top surgeons in the World are invited to vote and publish a consensus statement later. There is an increasing interest Worldwide, and from younger surgeons, to learn from this operation. We want to send the proper and right messages about the DS, and get rid of unscientific statements circulating."
I don't fully understand what you intended by your seemingly negative comment about him, perhaps due to your limitations in English (fair enough - I can order cerveza in Spanish, but that's about it), but what I think I did understand is that you think other surgeons' opinions (including the majority who do not perform the DS) make his opinion in some way per se questionable. Your finger-wagging should be done in front of a mirror.
As for your comment at the end of your email, in my experience, surgeons who have not one death are often cherry-picking their patients, and therefore not helping the ones in most need. And with all due respect, assuming only 200 lower risk (and lower efficacy, long run) surgeries on low risk patients, this number is not statistically impressive to me. How many of your patients are 10 years out and still healthy, successful (>50% EWL), free of comorbidities and report excellent quality of life? Those are numbers that impress me. I daresay the numbers for DSers, and in particular those who have received adequate nutritional advice, are superior to the numbers for other, less effective surgeries.
And while I think it is important to pre-operatively weed out patients who are not capable of being compliant with the minimal requirements of properly managing a DS (I would not be averse to both psych AND IQ tests), I am certain that the vast majority of problems that DSers experience are due to their surgeons' and treating physicians' lack of knowledge about long-term DS nutritional requirements, not lack of patient compliance or intractable defects in the surgery itself (aside from optimization of surgical parameters based on the patient's needs, but that's a different issue). I firmly believe that properly formulated clinical trials to test the results of the patients' empirical evidence of what DOES work would show this, and concomitantly provide even better evidence of the superiority and safety of the DS.
Moreover, I submit that misinformation in the form of denigrating a superior surgery because the surgeon doesn't understand it, can't perform it competently, and/or by failure to even disclose it at all (and thus not providing the patient with the opportunity to give fully informed consent), is also unethical and constitutes malpractice. In response to your outrageous assertion that "The miinformation in people like you is what kill patients," I challenge you to provide evidence of one single incident where information from "people like me" - by which I assume you mean intelligent, informed patients who disagree with inadequate nutritional advice from a surgeon - has killed anyone.
I respect your opinion, and have tried to keep my comments professional, but note that your comments come across as hyperbolic, arrogant, dismissive and baiting. I urge you to LISTEN to well-informed patients and DS surgeons with an open mind and with a mental filter that does not automatically exclude information that is inconsistent with what you think you know. And if you don't like what I'm saying, please consider ignoring me, rather than resorting to ad hominem attacks on my knowledge and ethics.
I hope that sits his ass down.
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