Mexican Surgery and Going it Alone

[DSRIGGS]

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. That would be a good idea, IMO. Just in case.

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 This is a non issue, IMO. My DS was done in a different hospital system than my PCP and frankly, most DS surgeons are worthless for routine follow up. Your PCP will order your labs and if issues arise I am sure your PCP can reach Dr Ungson for a consult.
Difficulty accessing and analyzing malpractice complaints and litigation in a foreign country

Does anyone have other thoughts on additional Pros and Cons?

See my comments in bold

 

[star0210]

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 Ungson in Mexicali last November for my VSG to DS revision. My husband was a bit skeptical when I first told him I wanted to go to Mexico for surgery but he started researching and reading and couldn't find a good reason to be against it. Now he praises it and the experience at Almater Hospital and Dr. Ungson and the other doctors and staff and wouldn't hesitate to recommend it. It truly was a very good experience and very easy as well. The hospital is one of the cleanest hospitals I've ever been in. They never stop cleaning 24/7.
My husband came with me, but I know of several people who went alone and had no issues.

To answer your specific questions:

1. You're not left alone to your own devices ever. They take care of everything. I arrived the day before my surgery. Ernesto (their usual driver) picked us up and we were taken straight to the hospital for pre-op bloodwork, chest x-ray, and barium swallow (I had this because I was a revision from a VSG...not sure if they do that for first time surgeries or not). Once everything was done, Ernesto brought us to the hotel. He picked us up bright and early the next morning and took us back to the hospital for surgery. He then drove us back to the airport when it was time to go home. Some people end up spending a night at the hotel before going home but in my case there were no rooms available so we just stayed the last night in the hospital. We arrived on Thursday, had surgery Friday morning, and flew home the next Wednesday.

2. Before they schedule you for surgery, you fill out forms including your medical history. In my case, there was nothing in my history that gave him any cause for concern and he approved my surgery. (Similar to other surgeries I've had...hysterectomy, back surgery, etc - no other pre-op testing was required other than bloodwork, chest x-ray, EKG). Nutritionists are a joke....don't waste your time or money.

3. Your PCP should order your bloodwork. Most (ok maybe not MOST, but MANY) people don't continue to see their surgeon after surgery is over. You may need to make the case to your PCP as to WHY you need all the tests we need and hopefully he/she will cooperate. If not, you find another one. I happen to be in the lab business so I order all of my own lab tests which is an option for people as well if they can't get a doctor to order everything they need. And again, no you don't need a nutritionist. Everything you need to know you can find right here on this site.

4. I think you answered your own question...

5. We flew into San Diego with a stop over in Houston I believe and were picked up at the San Diego airport.

I would do it again a million times over. It was just THAT easy.

 

[star0210]

Also I forgot to add...lots of people in the US travel out of town or to other states to have their surgeries. People travel all over the country to have surgery with Dr. K. It's not feasible for MOST people to return or travel for routine followup care. Most people have to find PCP's or other docs other than their surgeons for any type of follow up care and/or labs, iron infusions, etc.

I had my revision back in November of last year and I've not needed to see a doctor for anything related to my DS at all.

 

[Jen-2]

If you did self pay in the US w Dr. Greenbaum in NJ it may be similar in cost to Ungson. I paid close to $12,500 in February for my DS. I'm not sure how long it would take you to get on the surgical schedule from today but I'd guess not more than a few months. He usually agrees to an initial telephone consult once you have forwarded him your medical records. He will require a few pre-op tests. He does do his surgeries open - not lap.

 

[duh_Mom]

Hi @Clematis, I apologize for being late to the responding but wanted to throw in my 2 cents. I had DS surgery roughly 3 months ago. (self pay) I am 58 and thought I was relatively healthy for someone MO/ SMO. I was pushed to have a sleep study too and shit - now I use a CPAP machine because yes I have sleep apnea. I sleep on my side too, but snore on my back. well, guess what, I roll to my back when I am asleep. The cpap did / does make me have more energy in the daytime. Once I got over the embarrassment of needing it and wondering if it would scare of the wife, I am glad to have it and don't sleep without it.

as for Mexico - I honestly could not recommend going anywhere and having this surgery alone. I expected to do very well, 2 nights in the hospital and then I would be on my way. Instead, I had an incarcerated bowel that required a second surgery, a 7 night hospital stay, went into shock and a return trip to the hospital 3 days after discharge to have over 12 ounces of fluid removed from my right lung, among other little piddly things. I did not really know what world I was in a couple of days in the hospital. I cannot imagine being in it alone, thousands of miles from home in a country that does not speak English as the primary language.

Now, obviously others have been there and done very well. I just encourage you to consider the possibility that complications may happen and have a plan of action if they do happen.

I am a nurse and feel like for any hospitalization someone needs to 'stand guard' - for even the most routine procedure. The DS is not a routine procedure, it is a complicated, complex procedure. Once I made the decision to self-pay I did not have all the waiting and other stuff. I did need to wait on my surgeon to be available. He had just come off a vacation and was scheduling 6 weeks out, but his partner would have been sooner.

Of course it is your decision and I absolutely think you are doing the correct thing getting different folks thoughts and experiences. I'll look forward to your decision and watch your progress. Good luck!

 

[Clematis]

Thanks duh_Mom. I can't argue with anything you've said. I firmly believe every hospital patient needs family/friend "oversight committee" as every hospitalized family member of mine has had serious, life threatening omissions/errors in medical care. I cannot do it alone, especially at age 62. (Ungson won't even operate on anyone over age 68.)

I also believe in hoping for the best but planning for the worst. I am not fully comfortable having such serious surgery anywhere but in my own hometown. You were in the hospital 2 weeks -- that's a long time for a spouse to be away from home and the office and family. Unfortunately, no one in my hometown will give a DS to a 40 BMI. (According to his website, neither will your Dr. Boyce.) I should have put that in my Pro list for Mexico. The best I can do in town is a VSG or a RNY, neither of which I really want.

I'm feeling discouraged.

Regardless, I will ask PCP to order sleep study when I have my physical next week. As you lose weight, is it likely you will not need the cpap?

 

[DSRIGGS]

Clematis - Take this with a grain of salt. I was supposed to wear a CPAP for 10 years and was told about how wonderful I would feel (mom and dad both wore them and said they were the best thing ever). I just couldn't wear it as it felt like I had a shop vac blowing down my throat and it choked me. I eventually got a BIPAP and it was much easier to wear, but it still didn't make me feel more rested. I felt more rested not wearing the head gear.

As my weight came off I stop snoring, at least not earth shattering like it used to be. I now tease my wife, who used to wake me up all the time beause I was snoring too loudly and tell her she is snoring to darn loud and she is going to have to go to another room.

 

[hilary1617]

@DSRIGGS, I can totally related I used BiPAP from the start and was never particularly comfortable or thrilled with how I felt. However, for me the key benefit that outweighed the inconvenience was reduction of my elevated risk of death from severe sleep apnea.

I had a friend, obese, but not morbidly so, pass away in her sleep in her late 30's due to a cardiovascular event that was ultimately attributed to apnea and so I read numerous studies on the matter when my pre-op testing revealed a severe problem of my own. There's definitely a significantly increased risk of death during sleep for folks with severe, untreated sleep apnea. Here's one example ---> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542950/

Fortunately, post DS my apnea resolved and I am now free of my Darth Vader mask!

 

[southernlady]

Thanks duh_Mom. I can't argue with anything you've said. I firmly believe every hospital patient needs family/friend "oversight committee" as every hospitalized family member of mine has had serious, life threatening omissions/errors in medical care. I cannot do it alone, especially at age 62. (Ungson won't even operate on anyone over age 68.)

I also believe in hoping for the best but planning for the worst. I am not fully comfortable having such serious surgery anywhere but in my own hometown. You were in the hospital 2 weeks -- that's a long time for a spouse to be away from home and the office and family. Unfortunately, no one in my hometown will give a DS to a 40 BMI. (According to his website, neither will your Dr. Boyce.) I should have put that in my Pro list for Mexico. The best I can do in town is a VSG or a RNY, neither of which I really want.

I'm feeling discouraged.

Regardless, I will ask PCP to order sleep study when I have my physical next week. As you lose weight, is it likely you will not need the cpap?

Then that has changed. I'm a Boyce DSer, starting BMI was 35.2.

He did make my common channel a bit longer but I told him why it was the DS or nothing.

 

[DSRIGGS]

@DSRIGGS, I can totally related I used BiPAP from the start and was never particularly comfortable or thrilled with how I felt. However, for me the key benefit that outweighed the inconvenience was reduction of my elevated risk of death from severe sleep apnea.

I had a friend, obese, but not morbidly so, pass away in her sleep in her late 30's due to a cardiovascular event that was ultimately attributed to apnea and so I read numerous studies on the matter when my pre-op testing revealed a severe problem of my own. There's definitely a significantly increased risk of death during sleep for folks with severe, untreated sleep apnea. Here's one example ---> http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2542950/

Fortunately, post DS my apnea resolved and I am now free of my Darth Vader mask!

@hilary1617 yes you are absolutely correct. I simply couldn't do the darn thing because I just couldn't get any rest. I tried all kinds of different head gear but nothing ever worked.

I know I was taking a risk and that is why I said take my comments with a grain of salt because I would never advise anyone not to address their apnea. Just another reason I needed the DS.

BTW I am so sorry about your friend. That is tragic. She unfortunately is a great example of just how important it is to take apnea seriously.

 

[Clematis]

I told him why it was the DS or nothing

Maybe he advertises DS is only for >50 but can be negotiated down. With that in mind, perhaps it is worth pursuing this with a local surgeon.

 

[southernlady]

Maybe he advertises DS is only for >50 but can be negotiated down. With that in mind, perhaps it is worth pursuing this with a local surgeon.

Actually what it says and has always said: The operation is usually but not always reserved for super obese patients (BMI > 50).

I do know his partner will not consider the DS for anyone under a 50 BMI regardless of reason. But Boyce can be flexible. You just have to be more aggressive and understand why YOU want the DS.

 

[DSRIGGS]

Maybe he advertises DS is only for >50 but can be negotiated down. With that in mind, perhaps it is worth pursuing this with a local surgeon.

If there is a good DS surgeon in the area I would strongly suggest that you talk to them and don't take website statements as fact.

Actually what it says and has always said: The operation is usually but not always reserved for super obese patients (BMI > 50).

I do know his partner will not consider the DS for anyone under a 50 BMI regardless of reason. But Boyce can be flexible. You just have to be more aggressive and understand why YOU want the DS.

Marshall was exactly the same. If you provided a strong reason as to why you NEED the DS he would drop that stupid rule and do what was medically necessary for you the patient. I think he used that guideline to weed out people who have done no research and would not be good DS candidates because if you can't research this crucial surgery you will probably be too lazy to take supplements and eat properly

 

[Cj7Coy]

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?

@Clematis
I am going to my PCP today. My old PCP knew about it & would have supported me but he moved away. I'm going to my new PCP today so I hope everything goes well.
For me the decision was this:
U.S. Surgery cost $35,000 which I didn't have nor could I get a loan for that much so I wouldn't have been able to do the surgery. I did hear about dr Greenbaum, who is as cheap as Mexico but I also heard he only does open surgery not laparoscopic but I had already my surgery date set in Mexico.
Mexico at $12,500 made it possible for me to have the surgery. I was able to get a loan from my husbands 401k.
Yes, it's nice to have post op care but many Bariatric surgeons don't do a lot of post op care either. Yes they see you but don't generally run all/any test needed. I have the paper with all the test I need so I can get my PCP to run the test so I can be mine own advocate.
In many ways doing my surgery in Mexico educated me a lot because I did tons of research & got all the paperwork from my surgery & all test needed instead of relying on a Bariatric surgeon telling me what & when if any testing was to be done.

As for complications:
I have suffered from dehydration (with dizzy & weakness) for about a month since I have a gastric bypass 1 oz pouch & not a sleeve (but DS rerouting). I have had much difficulty getting liquids & protein drinks down but once I hit the one month mark I am much more able to get fuild & protein drinks down & am doing much better.
My greatest struggle now is getting my vitamins in. At a month the doctor wants me to start my vitamin regiment. My iron makes me very sick so despite the doctors order to take it fasting I'm trying it with a bit of applesauce to help.

Dr Ungson is happy to consult with my PCP but not sure if that will happen. If need be when I have complications I will make an appt.with Dr Ungson again. I may even do my yearly with him just to assure myself that all is well.

One thing I do worry about is a stricture. The doctor warned me because of all the scar tissue they removed I could get a stricture. If I do I need a Bariatric surgeon to open it up by inserting a 12-15m balloon. Regular endoscopic techs will most likely stretch it too much & rendered my surgery useless because they will stretch the ring to much. If you have a DS or sleeve then that probably not an issue since you have the pyloric valve.
Now the downside to a DS at least in my area is that most doctors around me believe a DS is for 60-70+ bmi & is horrible surgery so some doctors may have a bigger problem with DS then with a gastric bypass or sleeve.

 

[DSRIGGS]

@Clematis
I am going to my PCP today. My old PCP knew about it & would have supported me but he moved away. I'm going to my new PCP today so I hope everything goes well.
For me the decision was this:
U.S. Surgery cost $35,000 which I didn't have nor could I get a loan for that much so I wouldn't have been able to do the surgery. I did hear about dr Greenbaum, who is as cheap as Mexico but I also heard he only does open surgery not laparoscopic but I had already my surgery date set in Mexico.
Mexico at $12,500 made it possible for me to have the surgery. I was able to get a loan from my husbands 401k.
Yes, it's nice to have post op care but many Bariatric surgeons don't do a lot of post op care either. Yes they see you but don't generally run all/any test needed. I have the paper with all the test I need so I can get my PCP to run the test so I can be mine own advocate.
In many ways doing my surgery in Mexico educated me a lot because I did tons of research & got all the paperwork from my surgery & all test needed instead of relying on a Bariatric surgeon telling me what & when if any testing was to be done.

As for complications:
I have suffered from dehydration (with dizzy & weakness) for about a month since I have a gastric bypass 1 oz pouch & not a sleeve (but DS rerouting). I have had much difficulty getting liquids & protein drinks down but once I hit the one month mark I am much more able to get fuild & protein drinks down & am doing much better.
My greatest struggle now is getting my vitamins in. At a month the doctor wants me to start my vitamin regiment. My iron makes me very sick so despite the doctors order to take it fasting I'm trying it with a bit of applesauce to help.

Dr Ungson is happy to consult with my PCP but not sure if that will happen. If need be when I have complications I will make an appt.with Dr Ungson again. I may even do my yearly with him just to assure myself that all is well.

One thing I do worry about is a stricture. The doctor warned me because of all the scar tissue they removed I could get a stricture. If I do I need a Bariatric surgeon to open it up by inserting a 12-15m balloon. Regular endoscopic techs will most likely stretch it too much & rendered my surgery useless because they will stretch the ring to much. If you have a DS or sleeve then that probably not an issue since you have the pyloric valve.
Now the downside to a DS at least in my area is that most doctors around me believe a DS is for 60-70+ bmi & is horrible surgery so some doctors may have a bigger problem with DS then with a gastric bypass or sleeve.

@Cj7Coy I am confused by this statement I have a gastric bypass 1 oz pouch & not a sleeve (but DS rerouting). He didn't redo your stomach so you had your pylorus valve in place? That is one of the key reasons for a DS. Just curious.

Thanks