Saturday, January 17, 2015

Surgery Recap Series, Post #1—Pre-Surgery Week: Deciding Where to Go

For those who are regular blog readers, and specifically momblog or dadblog readers, today's entry might feel vaguely familiar. This post begins a series, which will effectively be my surgical equivalent of "the birth story," the often anticipated post after a parentblogger has been writing about an upcoming birth for months, and then sinks into the black hole of exhausting infant care, and is unable to post the actual details of the birth for a few weeks.

It took me FOREVER to post a birth story after having EJ, mainly because the birth was so darn horrific, way beyond the norm (as if the norm isn't just a freak show to start), and I just couldn't get pen to paper, so to speak. I didn't even want to think about it, and I certainly didn't want to scare anyone else. I believe what I wrote was pretty cursory, and within the following years, my blog revealed more details of the event as they were germane to new thoughts and feelings.

But, hey, here's the good news, readers! For those of you who are interested in what my experience of receiving a vertical sleeve gastrectomy was like, I can tell you this: it was MUCH better than birth! Maybe 10,000 times better? That sounds about right. Of course, I didn't get an adorable baby out of it, but I sure am sleeping better than I did when I came home with a baby.

So, for those who have been interested, here is the first in a series in which I flip back in time just over a month, and give my play-by-play account of my surgery experience. For those interested in this same surgery, and who may have questions, feel free to leave a comment with your contact info, and we can chat directly.

Pre-Surgery Week: Deciding Where to Go

After several years of research, attending informational sessions, and going back and forth with our insurance company, we got the final word that there would be no way that my surgery could be covered via insurance.

THIS IS A MAJOR SCAM. Obesity kills people, and bariatric surgery shows the most promising outcomes for helping to combat obesity, in conjunction with health behavior changes. I could go on and on about the silliness of all this, but suffice it to say, this isn't cosmetic surgery, and I hope that insurers stop thinking of it as an expensive elective soon.

At that point, I knew I would not be able to have the surgery here in Chicago, as the local (amazing) hospitals did not have a fixed, set rate for the surgery, which meant that I could pay as much as $55K once all the costs were covered. I felt pretty despondent, but after reaching out online to communities of people who were having/had recently had vertical sleeve gastrectomy, I discovered that affordable options were available if you were willing to travel.

For those in America and Canada who want to self-pay for surgery, the main affordable option is Tijuana, Mexico. For a set price (minus airfare), you can fly to San Diego, get picked up at the airport, brought to the hospital, receive surgery, get put up in a hotel after you are discharged, then brought back to the airport 2-3 days later. I had heard rave reviews online, and began calling different practices to determine who might be best.

Here's where things got complicated. There is an entire world of marketing and competition that happens in this industry, and surgeons have coordinators and staff members specifically hired to encourage you to use their practice, and to avoid others. Some folks had nothing negative to say about other doctors, others used vague jabs and innuendo to let you know other doctors were really not as safe, and a few basically called out others as butchers or hacks.

I found this entire process very difficult to swallow. I talked to some really great coordinators and some very thoughtful surgeons, and I know (through meeting others online who have had surgery in Mexico), that many of these doctors have excellent outcomes. Still, though, as an intuitive, it was hard for me to decipher through the propaganda to figure out who was best in this market. In addition, different doctors had wildly differing techniques, none of which I could verify as best practice through my own research.

It occurred to me around this time that, for general surgery, if you have a great local referral and good insurance coverage, you likely wouldn't ask so many technique questions. There was something about having to seek out providers, and having it completely in my own purview to make the decision, that brought me straight back to my days as a health care researcher. I simply could not get enough information. The problem: the more information I received, the less clear I was about my choice.

Throughout this entire discovery time, I posted my insights on Facebook, and got a lot of feedback from friends who work in health care. One of my former colleagues (when I was a health care researcher), who went on to become a registered nurse, reminded me to think volumes. Every surgeon can have complications: sometimes the best surgeons have higher complication rates, actually, because they work on the trickiest cases and/or the sickest people; volumes are the key to becoming an expert technician. It was nice to have my memory jogged about such an important point, especially as I was sifting through varying reports of outcomes for different surgeons via phones calls and online searches.

Around this time, I went back to a post I had made on a sleeve community forum, asking for self-pay physician referrals, and remembered that someone had recommended a surgeon in Michigan, only four hours away. I had also found a different self-pay doc in Michigan, one who has a terrific series of videos about obesity, the surgical options, and healthy eating/exercise.  

The first doc, Dr. Pleatman, was described as an excellent surgeon, but not the best interpersonally. The second, Dr. Weiner, was so engaging on screen, I wanted to find out more.

I made appointments with both, and was happy that, unlike with Mexico, I could meet these surgeons in person, not just online. I hit it off immediately with Dr. Pleatman's coordinator/receptionist, Cari. She was friendly, personable, and not the least bit a salesperson. She's a great ambassador for his practice. She also warned me that the doctor is not very "touchy-feely," or something like that, which was consistent with what I had heard from his previous patient. That's not why we hire surgeons, of course, so I wasn't deterred. When I called the second doctor, they were hesitant to book me, as I wasn't local, and had to get specialized approval.

Dr. Pleatman called me the evening I first spoke to his office, and I found him extremely personable. I was surprised I had heard otherwise. He was patient, went through my medical history on the phone, and made me feel hopeful.

A few weeks later, I travelled to Michigan, stayed with my aunt and uncle, who made me delicious meals and fancy cappuccinos, and interviewed both doctors on a whirlwind day.

In the end, I chose Dr. Pleatman, for a variety of reasons, and I am so glad I did. While surgery in Michigan is twice the cost as surgery in Mexico, it was one-fifth the cost of surgery here, so still a bargain. While I highly recommend Dr. Weiner's videos—truly, if you want to understand obesity, how this surgery works, what kind of diet is best, etc., he is your guy, and I am so grateful for what I learned from him via these videos—the main reasons for choosing Dr. Pleatman were, as follows:

  1. Volumes: Dr. Pleatman had performed at least 3 times as many surgeries, and that is just within recent years; beyond comparison between the two surgeons, specifically, his volumes are excellent (with a low complication rate, too.)
  2. Facility: The hospital at which Dr. Pleatman performs surgery was fantastic, and when you come from out of town, and don't know hospital reputations from local chatter, it is nice to find such a modern, well-equipped, and quite frankly, aesthetically lovely place to have surgery waiting for you. My aunt in Detroit, who is a nurse, liked that it was a part of the Catholic health system there, which she recommended. I like a nurse's approval!
  3. Out-of-Town Accommodations: From material on their (robust) website to the services provided at in-person visits, Dr. Pleatman's practice has everything worked out to ease this process for out-of-town patients. I got a special rate at a hotel just minutes from the office and the hospital that had a kitchenette (to make eating my specialized food easier), and received an hour-long consultation with both the nutritionist and the patient-care coordinator, with accompanying reference materials, diet plans, exercise plans, and dates to remember to take home.
  4. Trust: I trusted him, from the start. I realize this is intangible, but it may be the most important factor of all.
(There are a few additional reasons why I made the decision I did, and if you are someone considering this surgery with either physician, I would be happy to share my insights, privately. For public consumption, this is all I want to share.)

Once home, I began the process of ordering protein powders and vitamins, and starting my two-week pre-op, liver shrinking diet. I received great online support from Dr. Pleatman's nutritionist during this time, and the results were terrific. 

Interested in more? Stay tuned for more on my beautifully-small liver and my actual surgery!


  1. Hi Tori
    I too am considering this surgery with Dr. Pleatman. I was actually referred by Cari to view your blog. I would like to hear more about your reasons why you choose him.

  2. I always find it enjoyable reading your posts you have on your site. Will be returning often'keep it up!
    Cosmetic Surgery

  3. Tara, I'm sorry, but I'm just seeing this—would be happy to talk more about it, have Cari forward my info, or vice versa.