Mexican Surgery and Going it Alone

[Clematis]

I made a post yesterday about self-pay RNY vs VSG and, after hearing that basically they both are flawed and DS is better for me (which I suspected), members started posting names of surgeons across the country. It had never occurred to me to leave town, especially since there seems to be quite the hoops to jump through, even with self pay as I don't know how one goes to required support groups, nutritionists, psych testing when the surgeon is a 5 hour plane ride away.

And then some one said "Ungson" and then "Ungson in MX." I assumed the person's finger slipped off the S for MS and landed on X. My jaw dropped when it occurred to me they were talking about MEXICO. Who in their right mind would go to Mexico for major surgery? But I have let the idea percolate overnight.

Ungson is experienced and has very good reviews, or if the cynic in me is talking, a very good marketing team. It could be done soon vs a 4 month wait. It would save about $10k (but I don't want to base my decision on price.)

But assuming I can get over the apprehension of going to Mexicali to have my innards reworked, I have a few questions:

1. I would need to travel alone as my husband could not be away from the office for a week. The last time I was in Mexico was 35 years ago -- I went to Tijuana and Ensenada with a girlfriend and barely felt safe. Am I going to be OK navigating everything alone without an advocate after I am sliced and diced -- surgery, hotel, transportation to airport?

2. Am I on my own to arrange for pre-admission testing with cardiologist, endocrinologist, sleep testing? What else would I need? What about pre-surgery nutritionists? I assume I don't have to worry about the psych testing.

3. Post-surgery, is my PCP (who will go crazy over choosing Mexico vs Cleveland Clinic even though they rarely do DS and never on a LW) supposed to order the regular blood work? Do I need a nutritionist (who won't have experience with DS) or can I do it on my own armed with the internet, this board and a high IQ?

4. To whom do I go locally if there is an emergency? Hmm well since the only surgeon I am aware of locally who does an occasional DS is in the same system as my PCP, I guess she can sort that out. But I assume the cost of emergencies will be on me since I had a self pay surgery?

Because of all the airline consolidation, there are no longer direct flights to San Diego to get to Mexicali so I would be looking at 8 hours or more in air travel. (I'll ask if they also pick up patients in Phoenix where there are direct flights.)

I don't know (or care - it's my money) how my husband will react to WLS, but he will definitely think I am insanely foolish to go to Mexico. Maybe I'll wait until the last minute to tell him this part.

Thanks for all your wisdom

 

[Munchkin]

1) It can be done. Quite a few here who traveled further than that. I would suggest you take a friend to increase your own comfort level. But I can still remember Dr. Baltasar(Spain) telling my sister the bed was not her friend and she should go out and explore. He even gave us maps he marked with good walks/lots to see and shop through. As far as the safety thing goes, the docs in that area make their living off medical tourism and they do everything possible to make sure you are safe. Last I read, they do everything. Even meet you when you get into town. Provide transportation and send a nurse or visit you themselves at your hotel. Honestly the care and standards outside the US can be argued to be superior to what you will get here.

2) You negotiate with your surgeon what is required for preop testing and where it will be done. It is possible to go and have it all done there but it will probably add a couple days to your trip. But it will be less expensive to do it there! Sleep testing? Why bother? This is only to to rack up co-morbs so your insurance will pay. And they want to force you to buy a CPAP you probably won't use anyway. If you have issues, you would probably know it. NUTS are pretty useless in general. They don't understand the DS and how we lose weight. The way we eat flys in the face of their traditional knowledge. You are smart. You understand low carb, high protein, and high fat. You already know the rules.

3) You give your PCP a list of the labs you need. Or you order them yourself.

4) Any decent cutter will do. You might want to look into insurance for your surgery that covers complications. I know people who go outside the US for plastics do this all the time. I would discuss the travel thing with Dr. Ungson. He may know an easier way. And you arrange in advance to have wheelchair service at the airports. If you have friends or relatives at or close to your airports, you may want to break up your trip.

 

[southernlady]

Tagging @star0210 as she is an Ungson DS'er...recent one.

 

[Clematis]

Great info Munchkin. Thanks

1. I am a confident solo traveler. Last year I spent more than a month alone in Europe and had a great time. As long as things are going smoothly, medically, I am not concerned. It's if there is a complication where I may not be able to speak for myself, especially not in Spanish. There is no one who can come with me so I either have to accept this risk or scrap Mexico.

2. Good point about sleep testing. I didn't understand the need for it unless one suspected (or spouse suspected) that it was occurring. At the surgeon consult here, I said I snored on my back (I sleep on my side) but that was weight related and so WLS would probably eliminate that in a month. But they said I would be on my back, not side, after surgery and I could have apnea when I was groggy from surgery. To which I asked if they were going to slap on a cpap in the recovery room or if, gee, a nurse would notice the beeping machines when a patient in recovery had stopped breathing. I received a bewildered smile.

Thanks for tagging star0201, SL. [How can we PM members on this board? For some reason I am not seeing the button.]

Just read this on cdc.gov on the subject of medical tourism:

“Flying and surgery both increase the risk of blood clots and pulmonary emboli. Air pressure in an aircraft is equivalent to the pressure at an altitude of approximately 6,000–8,000 ft (1,829–2,438 m). Patients should not travel for 10 days after chest or abdominal surgery to avoid risks associated with this change in pressure.”

I think it prudent to err on the side of caution when traveling alone for surgery. Although I read a long post by someone who used Ungston and felt A-OK and itching to get on an airplane and go home just a few days after DS surgery (but she stayed in Mexicali for a week), perhaps I’ll spend a few additional days in Phoenix (or San Diego) with US hospitals nearby until I fly home.

Every WLS in the US has a 2 week follow-up appointment – does that just not occur with foreign surgeries? Is that safe?

PS: What happened to Kathy26 who posted on Mar 4 that she was thinking of DS, then again on Apr 8 saying she already had surgery with Ungston and awoke to learn he had only given her a VSG? I don't see any other posts by her. This was the first negative review I had heard of Ungston so I'd be interested in knowing more details if anyone has them.

 

[southernlady]

Thanks for tagging star0201, SL. [How can we PM members on this board? For some reason I am not seeing the button.]

On this software, it's known as "Start a Conversation". Click on their avatar (the picture above their name) and an overlay pops up. One of the options listed is to start a conversation.

 

[Munchkin]

I stayed in Spain for 3 weeks when my sister had surgery. Nothing wrong with being careful and it's not expensive to stay once you have absorbed the cost of getting there! We rented a condo on the beach in Santa Pola.

If you are already a traveler and not afraid, I would say go for it.

If you are doing well the 2 week checkup is hi, how you doin? Got any questions? Things you can easily do over the phone or skip.

Some people need handholding and others don't.

 

[DSRIGGS]

I would have to say, and I know others have done it, but no way in hell would I be alone after the DS and especially in Mexico. If you can bring somebody with you it would be money very well spent. You aren't going to feel like doing much of anything for a few weeks after surgery ...so just getting food and hydration to sustain yourself will be a huge task. The only way I would do it is if they are keeping you in hospital and taking care of all your needs for the time you are there, but if you have to go to a hotel or condo/apartment it will be tough.

 

[Clematis]

I think it's 3 nights in hospital and 2 in adjacent hotel.

You're the voice of reason, Scott. I really don't think I can do it alone. Bringing someone else isn't a matter of money, rather of ability to take time off work. My best bet is my husband but he is so very not suited for a caregiver role -- he's an irritable, Asperger-y attorney. (Surgery in Mexico is not going to go over well with him at all.)

And yet more to think about.

 

[Cj7Coy]

I made a post yesterday about self-pay RNY vs VSG and, after hearing that basically they both are flawed and DS is better for me (which I suspected), members started posting names of surgeons across the country. It had never occurred to me to leave town, especially since there seems to be quite the hoops to jump through, even with self pay as I don't know how one goes to required support groups, nutritionists, psych testing when the surgeon is a 5 hour plane ride away.

And then some one said "Ungson" and then "Ungson in MX." I assumed the person's finger slipped off the S for MS and landed on X. My jaw dropped when it occurred to me they were talking about MEXICO. Who in their right mind would go to Mexico for major surgery? But I have let the idea percolate overnight.

Ungson is experienced and has very good reviews, or if the cynic in me is talking, a very good marketing team. It could be done soon vs a 4 month wait. It would save about $10k (but I don't want to base my decision on price.)

But assuming I can get over the apprehension of going to Mexicali to have my innards reworked, I have a few questions:

1. I would need to travel alone as my husband could not be away from the office for a week. The last time I was in Mexico was 35 years ago -- I went to Tijuana and Ensenada with a girlfriend and barely felt safe. Am I going to be OK navigating everything alone without an advocate after I am sliced and diced -- surgery, hotel, transportation to airport?

2. Am I on my own to arrange for pre-admission testing with cardiologist, endocrinologist, sleep testing? What else would I need? What about pre-surgery nutritionists? I assume I don't have to worry about the psych testing.

3. Post-surgery, is my PCP (who will go crazy over choosing Mexico vs Cleveland Clinic even though they rarely do DS and never on a LW) supposed to order the regular blood work? Do I need a nutritionist (who won't have experience with DS) or can I do it on my own armed with the internet, this board and a high IQ?

4. To whom do I go locally if there is an emergency? Hmm well since the only surgeon I am aware of locally who does an occasional DS is in the same system as my PCP, I guess she can sort that out. But I assume the cost of emergencies will be on me since I had a self pay surgery?

Because of all the airline consolidation, there are no longer direct flights to San Diego to get to Mexicali so I would be looking at 8 hours or more in air travel. (I'll ask if they also pick up patients in Phoenix where there are direct flights.)

I don't know (or care - it's my money) how my husband will react to WLS, but he will definitely think I am insanely foolish to go to Mexico. Maybe I'll wait until the last minute to tell him this part.

Thanks for all your wisdom

I went to Mexico for a DS or RNY with Dr Ungson. I was a revision from a VBG which I had 20 years ago in Indiana. The VBG gastric pouch grew back to the old pouch (called a fistula) which caused me to gain the weight back.

Dr Ungson said he would try to give me a DS if it was possible but due to a stricture in the gastric pouch where the band was he preformed a RNY gastric pouch with a DS intestinal rerouting.

I had great care with his team. My husband couldn't come so I brought my 16 year old daughter. We were treated with great care. All his team speak English. Mexicali is not bad place either. My daughter took a few walks outside with other patient families that we got to know.

The hospital beds weren't that comfortable but I had the best care I could have asked for. I saw one doctor on the team everyday. I was a complicated surgery with lots of scar tissue that needed to be removed & the ring from the previous surgery. I needed someone skilled. Dr Ungso did an awesome job. Many of the U.S. Doctors told me I would be open surgery but Dr Ungson was able to do laparoscopically.

My surgery was Aug 6, 2015 & I've lost 33 lbs from pre op surgery diet until now. It cost $12,500 for my revision. It might be $13,500 now since they were running a summer sale. They pick you up in San Diego the day before your surgery & take you to the hospital where they run a few test on you. Then you stay in a nice hotel for the night & go to the hospital about 7 am to be prep for surgery.

Yes getting post op care is hard in U.S. & Bariactric surgeons aren't that happy to take you on. If you're lucky you may find one. For me I'm relying on my PCP to order my test & Dr Ungson says he offers post op care if you wish to travel & they offer email & phone post op care.

The one negative is I sent 2 emails with no response. But I do have their phone number so I will call them if I need.

I am very happy with the care I had from his team. hope this helps.

 

[DSRIGGS]

I think it's 3 nights in hospital and 2 in adjacent hotel.

You're the voice of reason, Scott. I really don't think I can do it alone. Bringing someone else isn't a matter of money, rather of ability to take time off work. My best bet is my husband but he is so very not suited for a caregiver role -- he's an irritable, Asperger-y attorney. (Surgery in Mexico is not going to go over well with him at all.)

And yet more to think about.

Right about the money part. It wasn't an issue for us either for my wife coming for my revision. She did FMLA to not use up all her vacation

I understand about finding someone to go with you. Not easy.

 

[Cj7Coy]

Right about the money part. It wasn't an issue for us either for my wife coming for my revision. She did FMLA to not use up all her vacation

I understand about finding someone to go with you. Not easy.

Also so you know how long the stay is with Dr Ungson for a DS it's 1 day in the hotel & 5 in the hospital. I stayed one extra day in the hospital since I was a revision.

 

[DSRIGGS]

Also so you know how long the stay is with Dr Ungson for a DS it's 1 day in the hotel & 5 in the hospital. I stayed one extra day in the hospital since I was a revision.

He doesn't want you in a local hotel for a week after getting out of the hospital in case something goes wrong?

 

[hilary1617]

Just my two cents, but I am strongly in favor of sleep testing for medical reasons. I never would have gotten it done myself had it not been part of my DS pre-op because I didn't suspect it at all. At the time, I actually believed I was a great sleeper. But, my surgeon insisted and it turned out I had a serious problem. Serious enough that he wanted me on the CPAP 30-60 days prior to surgery and to bring the machine to the hospital for immediately post-op because he was worried about potential heart failure risk. So, if you are at risk and a doctor advises, I would highly recommend getting it done.

 

[Cj7Coy]

He doesn't want you in a local hotel for a week after getting out of the hospital in case something goes wrong?

No but I think he keeps you longer than some in the hospital. You can stay a couple days longer in a hotel but that's not covered in what they quote you. They do make sure you aren't having any complications & run the swallow test & leak test on you before you are discharged. I appreciated that they kept you in a real hospital the whole time too.
But no there was no extra stay at the hotel. Once you test came back well & you stayed the 5 days, 6 days for revision then they released you.
Now if you were a sleeve patient you had those test after 3 or 4 days & were discharged but DS stayed 5 days & revision stayed 6 days. If you do have complications they will treat you as long as needed for no extra charge except what the hospital charges for more days spent in the hospital.

 

[Clematis]

CJ7 - thanks for the detail. I do appreciate it. In the US, I think they keep you in the hospital 2-3 days for a virgin DS, but you are expected to return in a week, 2 weeks, and regularly: 2 months, 6 months. The quotes I have gotten include follow up visits (at least for the first month) and further hospitalization/surgery due to complications for 30 days. But it's $34,000+ self pay. How did your PCP feel about surgery in Mexico and managing your continuing labs, etc? Will s/he have you have a follow up visit with a gastric surgeon or only arrange for that if you have an issue? It's been a month - how are you feeling?

Scott - If I did this with Ungston, I would probably stay in San Diego for a week to make flight travel safer and so if there were complications, I could go back across the border and be attended by him or if urgent, go to SD ER. In the US it might be easier to get the protein drinks I'd be living on for the first 2 weeks.

Hilary - thanks for the input on a sleep test. Regardless of surgery, I do snore so i could ask PCP to order this and it would be covered under my insurance as regular (not bariatric) care.

My calculus for self pay surgery with Ungston...

PRO:

Scheduling - no 4 month delay as in US
Cost - less than half that of US
Annoyance and additional expenses - no 3 months of pre-surg meetings with nutritionist. no multiple meetings with psychologist to administer the MMPI
Experience - Ungsten appears to have more DS experience than surgeons at Cleveland Clinic. Volume is a great teacher.

CON:

Is the standard of care really comparable to US?
Post surg complications - on one's own to find a US provider
Hygiene - although all reviews speak of visible cleanliness, there are also reports of bodily fluids deposed down drains and inconsistent glove use
Language barrier
Travel across country during recuperation
No easy coordination of care between PCP and surgeon as would be if DS performed in same hospital system
Difficulty accessing and analyzing malpractice complaints and litigation in a foreign country

Does anyone have other thoughts on additional Pros and Cons?