I don't want any yes guys in my vicinity. Even if it means losing their employment, I want everyone to tell the truth to me.
-Samuel Goldwyn, director
I recently had a question about starting a band. "You realize it isn't really about surgery, right?" I asked as my first statement. I was met with an expression of complete amazement. After all, they had read about "the surgery" online, they knew someone who had actually undergone "the surgery," and they had seen a newspaper advertisement describing how much weight a man had lost as a result of "the surgery." The process certainly seems to be secure enough. It appears to be a miracle treatment after years of weight-related struggles. Naturally, "I want one, too." Armed with this knowledge, some people are even willing to travel to a foreign nation to have someone they have never even met put a band around their stomach. They will likely never see this person again. Simple-right? Actually, no!
Bariatric surgery is appealing to people for a variety of reasons, but almost always with a sense of closure. It resembles a last-ditch effort to lose weight in many ways. I've heard a lot of patients remark, "I've tried everything else, so this just has to work." There is unmistakably a feeling of desperation, which is frequently accompanied by a direct assignment of blame for success or failure to the procedure. However, no matter the procedure, surgery by itself cannot resolve the issue. I'll use one as an illustration.
A few years ago, a woman came up to me after a presentation to ask if she would be a good candidate for the band treatment. She
I assumed that she would easily meet our requirements because she weighed roughly 350 pounds. She continued, though, by revealing to me that she had undergone a gastric bypass procedure and dropped 175 pounds 25 years ago. She regained all of her weight over the ensuing years. That indicated to me that she had stretched out the stomach pouch that the bypass had created, allowing her to consistently overeat in the same manner as she had before the operation. She continued by stating that the surgeon had effectively performed the gastric bypass again ten years prior in order to modify her stomach pouch. She shed 175 pounds once more, only to gain them all back over the following few years. She was now focusing on the AGB. I'd want to say that was the first time I had heard that particular tale, but that is untrue. Stories like this woman's serve as severe illustrations for me of the limitations of surgery as a sole remedy.
Is a Weight Really Necessary?
Administration Plan?
Getting a band should only be seen as the initial step in making significant and long-lasting changes to your way of life. The path to success includes changing your eating habits, what you eat, how and when you exercise, how you regard yourself, and the role that food plays in your life. All of these things, as well as others, must alter. Albert Einstein once said, "Insanity is doing the same thing over and over and expecting different results." This is one of my favorite phrases.
Instead than just getting an operation, you must alter your behavior. Can you implement those adjustments on your own? In my experience, very few people have the level of self-awareness, self-control, and self-motivation needed to change their lifestyles on their own.
The band is a tool, as we described in a previous chapter, but like any tool, it needs to be used properly to be effective. No virtuoso pianist simply sat down and started performing a Chopin concerto one day. Any tool must be properly used, and this necessitates supervision and ongoing direction in addition to training and practice. Describe it as coaching if you must. The band is a fantastic tool that, when used properly by a committed patient, may yield remarkable results. However, to achieve consistent and long-lasting success takes a team effort, and even then, the battle is not simple to win. A team of experts committed to supporting you in achieving your objective is necessary, as is your own commitment, to overcome a lifetime of obesity. It is crucial that your team and you have a synchronized plan that everyone is aware of and is willing to adhere to. What I mean by a program is this. Within a complete weight-loss program, the surgeon, dietitian, exercise physiologist, and psychologists all have distinct but equally significant roles to play.
The Doctor
The proper requirements for patients seeking the adjustable gastric band were covered in the previous chapter. Finding a surgeon and a thorough program is the next step, assuming those requirements are satisfied. It doesn't really matter if you locate the program first and work with a surgeon they suggest, or whether you find a surgeon who has created a program. It is important that you have a qualified surgeon and a thorough program.
In the early years of the AGB in the United States, it was difficult to find someone qualified and willing to perform band surgery. Nowadays, there are a lot more doctors performing these procedures, and there are virtually constant marketing for it. How then do you know where to turn? Is it sufficient to visit a doctor merely because a buddy did? Should you presume that they completed their research and picked the finest program and surgeon? These inquiries ought to have an obvious solution. You should conduct your own study before making a choice for anything this significant, even to the point of interviewing various surgeons.
Are you a portion of a complete program? is the first query you ought to put to the surgeon or the office personnel. The answer is obviously no if you phone a surgeon's office and inquire about their program, and they act as if they have no idea what you are talking about. If they say, "Yes, we have a support group that meets once a month," you should press them for further information. What you need is a well-defined program with professional supervision and support in the areas of nutrition, physical activity, and psychology. Never be afraid to ask a lot of questions. Find out who makes the adjustments, how they are made, what sort of nutritional advice is provided, what kind of psychological support is offered, whether exercise instruction is provided, and the procedure for following up. The surgeon should have made some arrangements for patients to receive all of these essential treatments even if there isn't a formal program in place.
Questions to Consider Before Selecting a Surgeon and a Program
Is the surgeon a part of an all-encompassing plan? (If they are unsure of what that implies, you already know the answer.)
Exists a patient support group for the surgeon?
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Who makes modifications and how are they done?
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What varieties of nutritional advice are offered?
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What kind of mental assistance is offered?
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Does the surgeon offer advice on exercising, and what happens after that?
Are these services delivered by qualified experts? (You're searching for certified psychologists, exercise physiologists, and dietitians.)
Find out whether your surgeon has any expertise using laparoscopic procedures. Has the surgeon performed laparoscopic suturing before? Is the surgeon accredited by the PALSS program of the American Society of General Surgeons?
What about patients who didn't do well or aren't losing weight? How many patients are having difficulties, and what has being done to assist them?
Which types of difficulties have there been? The three most frequent problems are infections, slippage, and band erosion.
To learn more about typical problems, what the surgeon does to help prevent them, and how they are handled when they do arise, ask the surgeon for an explanation.
What level of comfort do you feel?
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Ask the surgeon about their education, work history, and patient outcomes after confirming that they have access to or are associated with a quality program. Surgery underwent a permanent modification in 1988. That year marked the official beginning of laparoscopic surgery in the US. Since then, a wide range of procedures have been carried out using this ground-breaking method;
It's crucial to note, though, that not all doctors have adopted this approach to performing abdominal surgery. Many surgeons lack experience beyond the excision of the appendix or the gallbladder. Laparoscopic surgery has only recently begun to be taught in surgical training programs in any significant way, and many of the people "teaching" these methods have little to no expertise themselves.
The American Society of General Surgeons now offers a new certification program for laparoscopic surgical skills called PALSS, which stands for Proficiency Assessment of Laparoscopic Surgical Skills. This accreditation, which is based on an expert panel's peer review appraisal of laparoscopic skills, may give patients some peace of mind that their surgeon has shown his or her technical proficiency. Because the program is still in its early stages of development, it is not yet regarded as a standard in the surgical community. The PALSS software has so far only been used by a small number of surgeons, but it is a beginning.
A procedure for naming establishments "Centers of Excellence" for bariatric surgery has also been developed by the American Society of Bariatric Surgeons. These are frequently hospitals or surgical facilities that perform several bariatric surgeries. Such a categorization reflects the volume of operations performed in that facility more so than it does the specialized training of a given surgeon. The surgeon is the most crucial element of the equation, even while having an experienced staff and all the essential tools and services accessible at the hospital is an important portion of your care. It is not a guarantee that you will receive high-quality care just because a facility or even a specific surgeon conducts a lot of business.
The implantation of an adjustable gastric band laparoscopically is typically regarded as a rather complex treatment requiring strong laparoscopic abilities, especially the capacity to apply sutures. Ask the surgeon about their education and experience in laparoscopic suturing without holding back. If the surgeon has expertise with other complex laparoscopic procedures, even though they haven't conducted hundreds of banding surgeries, they may have the essential skills. You
Ask the surgeon about their background performing laparoscopic procedures such as colon resections, hiatal hernia repairs, antireflux surgeries, and other treatments. Any trustworthy surgeon will be delighted to share their knowledge with you. If the response you receive suggests that sutures are either unnecessary or insignificant, that ought to be all the information you want.
You ought to inquire about outcomes with the surgeon during your interview. Do not accept a response that is limited to citing the most recent medical research. You should be aware of the outcomes your surgeon achieves. Every surgeon will have a few patients who are recovering really well, and logically, you are more likely to hear about them first. Make sure to find out more about those whose outcomes weren't ideal. The surgeon will have some failures if they have performed the AGB operation for any period of time. Learn why the surgeon believes those specific patients were unable to accomplish their goal and what steps have been taken to help their outcomes.
Additionally, inquire about potential issues including band slippage, infections, and erosions. Before you even ask, the surgeon will probably provide you information regarding possible hazards, but if you're not happy with what you learn, don't be afraid to ask further questions. Make sure you understand them from your surgeon before reading the chapter on complications, which goes into further detail on this topic.
Personally, I believe that comfort level is one of the most critical factors to consider when selecting a surgeon. No amount of qualifications or affiliations with the most prominent medical institutions can match the sense of assurance you get after meeting someone in person. Some automated and hectic bariatric practices don't even see the patient until right before the procedure because of how busy they are. Although the surgeon may not mind this time-saving procedure, it is somewhat impersonal. Before making any decisions, you should insist on meeting the surgeon in person and specifically discussing the procedure as well as all the other matters stated before. If someone informs you that's not doable or if
There is merely a brief encounter Then you should probably find another place to be.