things that make you go hmm...

Porkchop :)

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Hi,

I am an international school teacher and I work overseas, so hoping to have a DS at the end of June or beginning of July so I will have maximum recovery time before I have to return to work in August.

I'm sure about my choice to have WLS and sure that I want to go with the DS. I will be self-pay so I have been checking into the best surgeons that I can afford. So far, so good.

I heard about Dr. Esquerra with Mexicali Bariatric Center and checked into it. He seemed like a good choice, so I contacted his assistant Nina.

My current BMI is 51 and I was asked to try to get it to 45 in the next month, which would mean a 45 pound loss in roughly 5-6 weeks. I am happy to do my best, but this seems a bit unreasonable. If I could lose that much weight in a month, I probably wouldn't be severely obese and looking for surgery. But again, I'm happy to do my best to lose weight. The rationale for asking me to do this (according to Nina's email) was not to shrink my liver, but because my intestines are currently "too heavy" so there is a greater risk of complications arising during the healing process. Okay, so I am happy to stay at the hotel longer until the risk of complications is significantly lower. This response was not acknowledged, but now the reasoning has changed to needing to shrink my fatty liver. This is what I have always heard in my research of the DS--I have never heard anything about intestines being "too heavy" and causing complications. I'm not saying it's not possible, just that I had never heard of that before.

Today I checked their website because I was trying to find the information of where to send the deposit. The website is down, totally down. I can't access any of it. I tried to call Nina to find out what was going on, but there was no answer, just a recording, which has never happened before. Nina has always answered, every time I called. So now things are starting to look a bit sketchy, IMO.

I've heard nothing but good about Dr. Esquerra and their facility, but all of these little things together are causing me some doubt. Is the website and the phone thing perhaps due to whatever issues that may come with being located in Mexico? (I don't mean to dump on Mexico--it's just that because I live overseas, I understand that things in other countries don't always work like they should, so sometimes I need to be flexible in my expectations.)

Anyway, advice? I need to schedule a surgery soon. Are these issues valid enough to constitute a red flag? Should I start looking elsewhere, or should I be patient and wait for these minor kinks to work themselves out?

Thanks in advance for your insight.
 
If their internet is down and they have VoIP phone, no phone. Could all be tied in to website. Don't be alarmed by that. But I don't think they do surgery on SMO (50+) as it becomes a more risky surgery. I hope you get it sorted out. Esquerra is a good surgeon.
 
I don't know for a fact that they don't operate on SMO, only that I've never heard of a SMO who went there, nor did I see anyone SMO when I was there. Funny, so many US surgeons will ONLY do DS on SMO. Can't win sometimes, huh? If you do get it sorted out with Esquerra let me know and I'll be happy to tell you all I know of my experience there
 
Yeah, that's why I was surprised that they wanted me to try to reduce my BMI so quickly. I thought that the one good thing I had going for me being SMO was that it meant a quick approval for the DS! Guess not in this case. I thought the reason why might possibly be due to the nature of their practice, where there is not a lot of long-term follow up. Do the surgery, go home, do your best, good luck. Since being SMO increases the risks of complications (and most complications happen within the first few weeks of surgery) but patients are discharged and return home fairly quickly, it could be that they are just trying to be responsible (and/or reduce liabilities) with their patients given their demographic and the nature of their practice.

I believe given his excellent reputation that probably everything is fine. It's just that when I am getting ready to wire large amounts of money to a foreign country, I tend to be more cautious and suspicious if there's anything that seems just a bit off. :)
 
It sounds like it could be just a glitch in the phone/electrical. And having spent time overseas, unlike those of us in the USA who expect it fixed yesterday., things are a bit more relaxed as to time in many other countries. (Example, I got my home phone finally installed 2 months after I moved into my apt in Europe. Here, it would have been done in less than a week).

BUT if you are uncomfortable with the other issue (and while the "liver shrinking diet" is called that, all it really does is make the liver less slippery). Takes much longer to actually shrink a liver. As in several months. Maybe as long as you are between a 45 and 50 BMI, he would be fine? Getting 10 lbs off would make a point or two difference, correct?

Other options are Dr. Greenbaum in NJ. He has the best self pay price here in the US. Or maybe Dr. Marchesini in Brazil? I don't know his cost but he has an excellent reputation.
 
I used Dr. Greenbaum. His rate went up, my DS cost 24k but it included a week in the hospital in a private room. I feel like I got amazing care and I am very happy with my decision.
 
Have you tried contacting Nina anymore? I haven't communicated with her for a while so just wondered. I would ask her exactly what she meant by "heavy intestines" and then about changing the reason on you, and see what she answers. I think the phone think was a system glitch but the other...
 
I noticed that they posted on their FB page noting their website is down temporarily, but it doesn't give a reason.

I didn't ask Nina about heavy intestines... to be honest I doubted that reasoning, mainly because in the US, they often don't like to consider the DS until your BMI is at least in the upper 40s to low 50s. I realize that sometimes the DS is a two-stage operation but for someone in my category (51 BMI, no comorbidities) it typically is not, at least according to the information I could find (Dr. Antone's office at Methodist Hospital in Omaha, among other sources). I came to the conclusion pretty quickly that "heavy intestines" was more of a concern about the rate of recovery and the likelihood of complications arising than a hard-and-fast rule. It says on the Mexicali website that their rate of complications is less than 1% and I attributed some of that to them being careful in the screening process. After all, they won't have a chance to actually meet me in person until the day before the scheduled surgery. So I suppose there are a lot of wild card issues that could arise during all of the pre-op testing that may need to have a bit of wiggle room or some sort of allowance made. That's why I thought it might be better if I stay at the hotel for an extra 3-5 days so they can monitor me for just a bit longer before I go back home.

Nina did indicate in her previous emails that it was my choice if I wanted to do the DS or the sleeve, and although she did try to steer me toward the sleeve a bit at first, it was always left up to me. Every time I have called Nina she always seems to be really busy. She does email me back although it's usually closer to 48 hours. To be honest, contacting that time zone is always a bit tricky for me because I live in Shanghai and the time difference is 13 hours. I usually rely more on email but because surgery is such a personal, thoughtful decision I feel a little more comfortable speaking to someone in person.

Anyway, this is a really busy time of year for me too, which is good I guess because I haven't had time to get too worried. I've noticed many people on this board have been happy with their experiences with Dr. Esquerra and there's even someone there now who is having this done and has been checking in on the board. So the more I've thought about it, the more comfortable I am. Obviously it's not some fly-by-night place that is going to pack up and disappear in the middle of the night. So I'll let Nina know that I'd like to schedule a surgery and see what the response is. Hopefully all will go smoothly. We'll see!
 
I called them only once. The connection was bad and I was impatient. After that, I used email and generally got an almost immediate response unless I put something vague in the subject line. Put something specific in the subject line... or alarming if you want a reply ASAP. (But if you are emailing them at 2am their time, its unlikely you'll get an immediate reply.)

Good luck with your decision!
 
Not sure what the problem was but it's definitely not an issue any more! This morning I awoke to 7 new emails from Nina, hahaha. They received my deposit. My, my, my, look at all the attention I get as soon as I give them money! ;) hehe

Anyway, glad this part of the process is done and we are ready to move ahead toward the goal. Looking forward to better health, feeling more comfortable in my body, and best of all, being able to relax and spend time at home with family during summer vacation. :)
 
Congratulations!

As another recent DSer living in Asia, I would also recommend you take the opportunity to stock up on vitamins, protein powder etc while you're home. I use iHerb to get my vitamins, but it's more expensive and less convenient than Amazon/Costco etc. Also start planning for high protein, low carb meals when you get back to Shanghai, as so much in our diets is based around rice and noodles - it takes some work at first!
 

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