Journal of my surgery with Dr. Ortiz at OCC

NoWorry · 05-22-2007, 07:01 PM

Step 1: The decision

I was banded by Dr. Ortiz in Tijuana, Mexico on May 16, 2007. As far as I can tell, the procedure was a total success and my first three days of recovery have been excellent.

During my research, prior to my banding, I looked extensively for a complete picture of the entire banding experience. While I found mounds of useful information in forums, magazines, books and internet articles, I was unable to find a complete picture.

This, then, is mine. I hope it helps you.

I have been obese for around 9 years. I spent almost all of those years trying to lose the weight. If you’re reading this, you already know what it’s like to obsessively battle obesity. And to fail. Early this year, I decided on a last ditch effort to lose the weight. It failed. So I decided the only remaining option was bariatric surgery.

Initially, I explored the idea of Mini Gastric Bypass. The surgeon who invented the procedure and still does most of them, Dr. Rutledge, coincidentally performs the procedure – out of all the hospitals in the US - at the hospital three blocks from my home. Surely a sign from the heavens. I joined his forum, requested his Patient Manual and started doing my homework.

Turns out, most of the members of his forum had, for months, been eagerly awaiting a TV documentary called “Action Hero Makeover” which documented the surgery and its effects on Gil Gerrard, the hero of “Buck Rogers in the 25th Century,” a hit series in the late 70’s. The special was scheduled to air for the first time the very next day. Another sign!

But as I investigated the procedure further and discussed it with my family and friends, it became apparent that it was not for me. My BMI wasn’t high enough and I failed at least another 3 or 4 items on his qualifications checklist. He had performed only a few thousand procedures and the complication rate was exceptionally high.

Still, what blew me away was the extensive detail and the wealth of information he provided in his Patient Manual. If only something like that existed for the Lap-Band®, most of us in these forums would have far fewer questions.

I decided to check out the Lap-Band® procedure. I found a friend who had been banded 5 years ago (17th patient in Nevada, it turned out) and a number of her friends had followed. They had all had excellent results, negligible complications and recommended it highly.

According to my homework, there have been more than 270,000 of these procedures performed worldwide, the complication rate is below 2% and those were mostly mild and easily correctible and the mortality rate was negligible. Weight loss was slower than with MGB, but most doctors feel that’s a healthier approach. Finally, it’s completely reversible.

I was decided.

NoWorry · 05-22-2007, 07:02 PM

Since my friend was the deciding factor, it made sense to approach her doctor’s clinic first. I called their office and was informed that the procedure costs $16,000. Add another $1,000 for pre-op testing. Total: around $17,000. Pricey. But when I considered that this is going to change my life in so many positive ways, I gulped and started convincing myself that I couldn’t afford to NOT do it. Then I started hearing a few things about the doctor. Not a pleasant guy. Arrogant. Uncommunicative. A**hole. Hmmm. Maybe another doctor?

I got on the internet, Googled “LAP-BAND® Surgery” and couldn’t believe the number of hits I got. Very few publish the cost on their sites, but most offer to send it by email. I accumulated a bunch. Lowest around $7,000, highest just under $9,000. Not only that, but these were all-inclusive prices. Nothing extra for tests. Free consultations with a nutritionist. Included rides from and to the airport. Patient coordinator provided. Every aspect of the procedure covered. Cool.

What tipped the balance in the end, were the testimonials from the hundreds of bandsters who posted their Mexico experiences on all these forums. It sounded almost like a cult. Even those who were disappointed with their results raved about their experience. Some were in pain, some were confused, some needed more attention, but they all still had nothing negative to say about the quality of care they received.

Half the price compared to the US and infinitely better care? Easy decision.

NoWorry · 05-22-2007, 07:02 PM

I made a spread sheet and started listing all the pros and cons for each doctor. I factored in cost, level of care, distance to travel, cost of travel, number of procedures performed by each surgeon, quality of my contact with them and a bunch of other less tangible elements.

I ruled out Cancun – too expensive. Acuna – too far. Mexicali – too much driving from San Diego. Not only was Tijuana the most convenient, but it also had the most surgeons to choose from: Reis, Corvala, Valencia, Ortiz.

In the end I chose Ortiz and the Obesity Control Center. The decision was not an easy one and it was not easily quantifiable. A lot of it was just gut reaction. And in the end a few of them turned out to be very erroneous, but I didn’t know it at the time (more about that later). But the list of pros and cons was something like this:

CON:
- Most expensive of the bunch ($500 more than next highest)

PROS (in order of discovery, not necessarily the order of importance):

- The Patient Care Coordinator, Lori, had exactly the right balance of friendliness and professionalism (at least one of the others was scattered, but pushy, another lacked professionalism, a third was very slow to respond)
- I had to spend only one night in a hospital and two in a hotel (my second choice required two nights in a hospital and one in a hotel)
- This was a private clinic (hospitals often have last minute scheduling problems)
- Dr. Ortiz had performed the most surgeries (although at least one other had very impressive credentials)
- He had written a book on the subject
- The members of the forum were extremely positive (some even fringing on raving fanatics!)
- The doctor’s mother is the patient coordinator for all patients. She would guide each patient through each stage of the process (this was probably the single most strongly determining factor for me – it indicated to me a very personal, familial touch. I can’t think of anyone better to hold my hand through the process.)

I spoke to my best friend and most trusted advisor and the first thing he said was that, unless it was really significant, to keep money out of the picture. There went my only con. Decision made.

NoWorry · 05-22-2007, 07:03 PM

In spite of all my tendencies towards research, I’m not much of a people person. I like data, I like statistics, I like information. People tend to confuse me. So I talked to no one prior to departing for Mexico. Lori e-mailed me all the documents that I needed, I read them, signed them and sent them back. On one occasion, I felt I needed to call her in the interest of due diligence, but I got her voicemail. Whew. Dodged that one.

On the evening before my departure, I spoke to all my friends and loved ones. The main question was the same: Are you scared? No, I replied. I’ve done all I can. I’m going to be sedated. It’s all in their hands. I’ve picked the best team I could find. I can’t do any more than that. Thanks to my research, the information Lori had provided, and reading the forum extensively, Dr. Ortiz and his team had my ultimate trust: I was ready to put my life in the hands of someone I had never met or even talked to!

I land in San Diego. I’m told Francesco, the driver, will meet me by the baggage carousel. He’ll be wearing a green tag and carrying a card with my name. Good plan.

I walk down to the baggage claim area and scan the long line of receivers in suits and brightly colored polo shirts. Cards like “Barney Smith,” “Motorola.” “Mr. Jack Carrington,” etc. No green tag. No card with my name.

I wait for my bag. When it arrives, I walk the gauntlet of receivers again in case I missed Francesco. Nope. I realize how difficult it is to spot something as small as a green badge. An orange polo shirt. That was the guy easiest to spot. Some other company had picked a more easily distinguished identifier.

Finally, I call the number for the clinic. I don’t know her name at that point, but Claudia answers. The driver’s running just a little late, she tells me, he’ll be there very soon. I’m a huge fan of precision. Very soon is meaningless to me. 5 minutes, I understand. 15 minutes, I understand. (I’m not so crazy about 15 minutes, but I do understand it.) Very soon? What on earth does that mean?

Just two minutes as it turns out. In a sea of neat, printed cards, I see a folded piece of paper with my name hand-scrawled on it. Misspelled. The guy carrying it has no green tag. My most generous assessment of his appearance is: scruffy. In fact, I’m half expecting him to offer me drugs or take me to the nearest brothel than drive me to OCC. I ask if he’s Francesco and he nods yes.

He asks me to wait and brings around a white van. It’s…. also scruffy. My level of trust is deflating. We start driving to the border. A short distance away, he makes a cell phone call and speaks in Spanish. We pull to a halt at Immigration. An official approaches and starts to speak to me in Spanish. Francesco, still on his phone, signals that I should go with the official. I follow him.

I mentioned earlier that I’m of Indian origin. What that means in this context is that I’m often confused as Hispanic and because of this most Mexicans assume that I speak Spanish. In fact, I do not. The official fires off another speech in Spanish. I look blank. Finally, he seems to realize that I don’t speak the language. He points to a button on a sign post that has a red light and a green light on it. It looks like the button you’d press if you wanted to cross the street. I press it. The light turns green. The inspector waves me back to the van and wanders off. I climb into the van and Francesco drives away still chattering on the phone. As best as I can figure it, the signal is a randomizer. When it turns red, the inspector is obliged to do something – probably search the visitor’s belongings, or check his ID, or something.

Entering Tijuana, Francesco puts away his phone and asks me if I want to go the Clinic or the Hotel. Huh? I get to decide? He sees my confusion and appears to make up his mind. A few minutes later, we pull into an underground garage. He takes out my bags, points to an elevator and tells me to go to the second floor. I’m puzzled and no longer remotely certain that things are going as they should. Suddenly he appears a lot more confident and urges me to take the elevator to the second floor. Up I go.

NoWorry · 05-22-2007, 07:04 PM

It’s around noon and the lobby of the Obesity Control Center (OCC) is busy. I approach the receptionist and identify myself. She seems to be expecting me. Whew.

Did I bring the originals of the documents that I had faxed over? Yes. She takes them. Now she has a few forms for me to sign. She hands me a few sheets of paper. Name here, doctor’s name here, write “Tijuana” here, and sign. As I’m following her instructions, I glance at what I’m signing. It’s a release form in case of my death during surgery. I acknowledge, it says, that I have been notified that I may die or that other horrible things might happen to me and I indemnify the Clinic.

Holy cr@p! I’m standing at the receptionist’s counter while she is multi-tasking with two other patients, with a phone to her ear, and so matter-of-factly, with no discernible weight given to the possibility of my death, merely points to the spot where my signature should go and has already turned her attention elsewhere.

When I had Lasik eye surgery a few years ago, statistically a far safer procedure, a senior patient coordinator took me into a private office, explained the risks of the surgery in very solemn tones, invited any and all forms of questions, offered to bring the surgeon to the room if I had any questions and only then asked me to sign the release form.

My knees go a little weak. My trust indicator slid substantially lower and the fear level that just the previous night I had said was close to zero started sky-rocketing. For the first time, a little voice far, far in the back of my head asked quietly if there was any easy way to get out of this. But given that I had traveled to another country, had already paid the full amount for the surgery and turning back appeared to be a monumental task, the risk/reward ratio - weighted as it was by the gravity of all the steps that I had taken – still favored continuing.

I signed the forms and politely asked for copies for my records. Ditto for all the other forms I had just handed over. Claudia, the receptionist, politely agreed to have them ready before I left.

A word about Claudia at this stage. I don’t have to tell you what my initial impressions were of this process up to this point. But I would be remiss if I didn’t say right here and now that as events unfolded further and the process continued, I came to conclude that Claudia is an exceptional person, a totally unflappable employee capable of handling literally countless tasks simultaneously without any change in demeanor or any diminishing of ability and all with an incredible level of humility and compassion for others. By the next day, she had become my go-to person for any problem, any question or any assistance, and she did not fail me once!

The procedure for pre-ops went fairly smoothly and efficiently in spite of the number of people in the waiting room. Some were patients on their way out, some were there for fills, some were having dental procedures done and a few, like me, were checking in.

The blood test was quick and virtually painless. Then came my consultation with Dr. Miranda, the nutritionist. She had big, brightly colored pieces of felt with pictures of food groups as teaching aids. My niece, who is in kindergarten, would have ooh’ed and aaah’ed. Dr. Miranda also had a PowerPoint presentation on her notebook computer. My nephew in the 4th grade would have been wide-eyed with wonder. Even if he, like me, had received the printed contents of the presentation in advance and had already studied them carefully.

I, on the other hand, was dumbfounded and wondering why I was being treated like a mentally-challenged idiot. I know what chicken looks like without having to be shown a piece of felt with a chicken leg imprinted on it. And believe it or not, I actually know what an apple looks like!

The post-operative instructions were surprisingly general and vague. As a group, we, the obese, are dieting professionals, We’ve lived and breathed countless diets for years, even decades. And I’ve not done one, single diet that didn’t come with hundreds of extremely precise instructions.

In that context, “drink liquids” is not an acceptable instruction. Drink 6 oz of apple juice twice a day. That’s the kind of instruction I need. When I asked later for more elaborate information, the instructions were a little more specific but still far from satisfying. I will look for nutritional information elsewhere.

Don’t get me wrong. As a person, I liked Dr. Miranda. She seems bright, intelligent and personable. But also distracted, uninterested and not really present. And as a nutritionist, she was of no help to me.

I think I understand now why the weight loss results of patients in the period between surgery and the first fill varies so wildly. It’s because of how each individual interprets the nutritional instructions. To one, “drink liquids” could mean an unlimited quantity of juice each day, while to another it could mean unlimited water and perhaps a few sips of broth and Gatorade.

Next, on to Dr. Jimenez who performed a lung capacity test and an EKG. Boy, this guy impressed me. He was personable, focused, knowledgeable and felt very trustworthy. As with Dr. Miranda, I really like Dr. Jimenez. But I also trusted him and he added benefit to my life. After a long slide downwards, my trust scale notched slightly upwards again.

Pre-op tests are all done now. In spite of the number of the number of people in the lobby, the entire procedure has taken less than an hour. I suspect that at a US clinic or hospital the same set of procedures would have taken at least twice that time, if not significantly longer.

I’m now approved for my surgery. Green light. All stations go.

NoWorry · 05-22-2007, 07:05 PM

Now I just have to wait for Mrs. Ortiz to drive me to the hotel.

And wait.

And wait.

A little over an hour later, Mrs. Ortiz arrives. Not so much as a hello, a nod, or an acknowledgement. She’s a busy, busy person. Things to do. People to meet. She disappears into the back in a flurry of activity.

She re-emerges around 10 minutes later. No introductions. We must be old friends. She looks to me and says “let’s go.” Now a bit about this woman. By my calculations, Dr. Ortiz’s organization pulls in somewhere in the region of $12 million a year. That’s based on 52 weeks of surgeries. Perhaps subtract some for travel, medical conferences, training, proctoring, etc. And that’s gross, of course. The net figure has to be lower. Mrs. Ortiz looks like a woman who has lots and lots of money. She’s immaculately groomed, perfectly coiffed and has a very significant presence. She also always, always has a smile on her face. Whether she means it or not.

With all that wealth, all that freedom, you’ve got to think that she does this job because she loves it, no? As far as I could see – no.

She leads me into the elevator, directs me to her fully loaded, leather-trimmed, Volvo sedan, pops the trunk and tells me exactly where to put my luggage. Apparently, previous patients have not indicated an ability to load a car trunk without instruction. Even before we pull out of the garage, she’s intercomming on her phone, and doesn’t stop until we reach our destination.

The drive to the hotel is a mere 5 minutes. We pull into the driveway. She pops the trunk for the porter. She points to a spot outside the front door of the hotel and tells me that that’s where she’ll pick me up between 7:30 and 8:00 the next morning. I’m not a morning person, so I ask if it could be any later. After all, there are going to be a number of patients. Perhaps one of the others would prefer an earlier call time and I can get a slightly later one?

Oh, no, she says. That’s not an option. In fact, if I arrive even at the tail end of the range she’s provided, I’ll have to wait a long time in the Clinic lobby since it’s a very slow process to check in each patient. Best if I’m there as early as possible.

SIDE NOTE: When it came down to a choice between the final 2 clinics, one of the cons for Obesity Good-Bye (OBG), a competitor, was that they required a hospital stay for both of the first two nights. I felt that I would sleep better in a hotel room rather than a hospital bed, and could sleep later and wake up more refreshed. Now, with such an early pick up I’m suddenly double-guessing my reasoning.

So alright, I’ve come a long way for this surgery, waking up early one morning isn’t going to kill me. Fine, I tell her. Now what do I bring? Where’s my surgery arrival checklist?

Early in my decision-making process, I received an email from the Acuna clinic that showed their instructions for what to bring to the clinic at the time for surgery. It pointedly specified that Sleep Apnea patients should bring their CPAP machines and ensure they are properly set-up prior to surgery. I have Sleep Apnea. I’m expecting her to confirm that I should bring my CPAP, give me guidelines of how to dress, perhaps to bring a toothbrush, a comb, slippers?

Oh, you’ve come alone, she asks. Yes, I’ve come alone. You may have to checkout tomorrow morning. Huh? This wasn’t in any of the documents. Yes, she continues, the room is just for patient’s guests. Since you don’t have one, you may have to give up your room.

I don’t like this one little bit. But I remind myself, she’s not saying I HAVE to do this. She’s just saying I MIGHT have to do this. Apparently I’m the first patient to ever come here alone. I guess I should feel special – they’re going to have to come up with a new rule just for me! She’ll call me later that evening and let me know if I should pack all my stuff when I get ready the next morning. SIGH. And then she’s gone.

It suddenly dawns on me that I’m standing out in the driveway with no instructions on checking in. Whatever she’s doing for OCC, Mrs. Ortiz is definitely NOT facilitating this patient. I go in to the front counter and the clerk asks me if I have a reservation. Do I? I don’t know. I give my last name and he brightens. Yes, there’s a room reserved in my name. Whew.

He doesn’t ask for a credit card and I don’t offer one. It’s insignificant in this moment, but two days later when I need to make an emergency phone call from my room and my telephone isn’t activated for out-going calls because no one has asked for, and I haven’t given, a credit card for incidental charges, it turns out to be pretty significant after all. A mis-communicated error that occurred only because there was no facilitation between the hotel, the guest and the host.

My room is nice enough. A small stain on the carpet, but with reasonable amenities, a coffee maker, a fruit basket. It faces the front of the hotel and there is loud traffic noise and music blaring from a Ceramic Tile company across the road. If I had any energy left, I would ask for a change of rooms to face the pool on the other side. I’m usually a fighter, but by now all the fight has gone out of me. I’m physically run down and psychically exhausted. As independent as I like to think I am, a friend or family member would have been welcome at this stage. But I just couldn’t bring myself to drag a loved one down here and put them through the ordeal of hanging about while I had surgery. So I do the next best thing and get on the phone.

When I had arrived at OCC, my phone service provider stayed Cingular. When I got to the hotel, it changed to MexCel. A $0.99/minute roaming charge then applied. The next day, my phone switched to Novistar. And once it did, not only did the roaming charge still apply, but I was no longer in the US and had to dial US numbers with long distance prefixes and additional long distance charges also applied. Fortunately, OCC provides free long distance calling to the US, but when not in the clinic, many calls that I made cost as much as $4 a minute.

Only one other event worthy of mention on the day of my arrival. I decided to go for a walk in the afternoon. Not too far away, I could see Hospital Angeles (HA), where one of Ortiz’s competitors operates out of. In my decision-making process I had assumed that a private clinic would be favorable to a hospital, so out of curiosity, I walked to the Hospital and checked it out. Now don’t get me wrong, OCC is spotlessly clean. To enter the operating area in back, everyone must wear slip-ons over their footwear. And it’s pretty modern and tastefully furnished. But the parts of HA that I could see went even a step beyond. The place simply gleamed. The floors glared from the shine. Where OCC had benches with thin, slightly-worn cushions in the lobby, HA had luxuriant, cushy armchairs. Let’s just say if the state of the premises was the only deciding factor, the clear winner would be HA.

NoWorry · 05-22-2007, 07:06 PM

I set the room alarm for 7 a.m. I have my own travel alarm. I set it for 7:05 just in case. I wake up when the first alarm went off. I was making a pot of coffee when a buddy calls from the east coast. I happen to mention that the coffee is brewing. He asks if I’m allowed to have coffee. Shouldn’t I be fasting if I’m going to go under general anesthesia in a few hours? Damn! I remember reading that in the guidelines that I was sent three weeks ago. I’m not even allowed to have a sip of water! I would have thought that someone would have mentioned that the night before – perhaps in that pre-surgery/clinic admission checklist that doesn’t exist. Interestingly, at no time after I arrive at the clinic does anyone ask me if I have been fasting. I assume that none of the other patients is asked that question either. And if there’s someone there who wasn’t lucky enough to have a buddy call that morning…. Gulp.

I try to have a bowel movement (I did have a last supper the night before), but it’s too early by my internal clock and it’s pretty unsatisfying. I’m hoping that I’ll get another opportunity at the clinic, but it never comes. For the next three days I’m totally constipated from the lack of any solid food intake, and I’m very, very gassy which I know is to be expected from the surgery. A part of me is convinced that at least some part of the gas is coming from my failure to completely empty my bowels prior to surgery. Amongst my list of things to do if I ever have this surgery again, would be to have a laxative the night before surgery. Ah, how great it would have been to have a checklist! An accumulation of the wisdom of 4000+ patients!

I pack my CPAP machine, I include a Ziploc bag full of all the stuff that I’ve read about while doing me research on the internet: cough drops since my throat may be soar from the intubation, cough strips in case the cough drops don’t work, lip balm in case the intubation chapped my lips (this from my sister-in-law), gas-x strips, liquid Tylenol since some patients thought that the clinic’s pain medication wasn’t sufficient (in my case, it was), my regular medication for diabetes and cholesterol which I assume I’ll be allowed to take that night after surgery (I was), toothbrush, toothpaste, hairbrush. I have very detailed lists that I made on my own for every step of the surgery. Since they wouldn’t do it, I did.

I’m dressed in a loose pair of sweatpants, baggy t-shirt, an over shirt in case it gets chilly (and it’s very chilly outside that morning), sandals that can cross as slippers, but that have arch support for walking longer distances (I’m told that a lot of walking is encouraged).

I grab my bag and head on down by around 7:20 p.m.. One of my fellow-patients and her companion are already waiting. 7:30 to 8, Mrs. Ortiz had said. And she would probably have to make a number of trips to get everyone over there. It’s best to be one of the first. That was my information. The white Volvo pulls into the driveway at 7:55. All I can think of is that I could have slept another 35 minutes!

As my fellow patient and her companion are getting into the car, Mrs. Ortiz asks me where all my baggage is. Still in my room, I tell her. No, no, no, I had to be packed to vacate the room. But she didn’t call to tell me that last night. She brushes over that little fact. It’s imperative that I pack up all my stuff and bring it with me to the clinic. She’ll run the other two over to the clinic and then come back and get me once I’ve packed.

I am livid. As she drives off, I sit on the lip of the courtyard fountain and I can barely control my fury. This is simply wrong on so many counts. In addition, I’ve paid exactly the same amount as those patients who brought companions, so whether I’ve brought a companion or not is completely meaningless. If the price includes a room for three nights for them, then it includes the same for me.

At this point, all I want is to get the hell out of here. Away from scruffy drivers, away from poor information, away from a total surrender of control, away from Mexico. Just away!. I calm myself. I remind myself why I’m here. It’s not because of some room, it’s not because of some rich woman trying to save the cost of a room for one night. I know what I have to do. I go upstairs, I pack my suitcase, and I’m ready for her when she returns to take me to the clinic. It is a quiet ride and mercifully it’s soon over. (Most curiously, when I check out and I’m given a copy of the bill, the room has been billed for three nights. So I went through the inconvenience of re-packing, re-unpacking and all the angst around this for absolutely nothing. Thanks!)

And then, to my sheer amazement, things start to improve dramatically!

NoWorry · 05-22-2007, 07:06 PM

There’s a festive atmosphere in the OCC lobby. The three patients from the night before are ebullient and excited about their day of shopping. If nobody mentioned they’d had surgery the day before, there would be no way to know it. By 10 o’clock there’s not enough room for all the people in the lobby, and I have no idea who most of them are.

The first thing scheduled for me is a dental exam. There are mixed signals about this. One is that it’s a freebie given as a courtesy to all bariatric patients. The other is that it is a necessary function for post-surgery recovery to ensure proper chewing ability. Yeah, right! I’m guessing that it’s an attempt to drum up dental business. In the retail industry it’s known as cross-selling. I bear the burden cheerfully and it’s soon over.

Back to the waiting room/lobby. There isn’t enough room now for all the people present. But since everyone’s constantly moving around, there’s rarely a moment when everyone needs to be seated at the same time.

Just as I grab a magazine from my bag and open it, I am told that they’re ready for me, and a doctor leads me to the back. Now I must confess that I didn’t get the names of all the doctors who I met. There were at least 5 of them and they all introduced themselves pretty quickly and in a very short period of time. This one is young and handsome; I’m sure most of the women patients swoon over him.

He leads me to a private room in the back. It’s very comfortably furnished. There’s a hospital bed, of course, a couch, an arm chair, a side table and a big plant in the corner. If it wasn’t for the hospital bed, it would feel like a small hotel room in an expensive city like Manhattan or Tokyo. There’s a flat screen plasma TV on the wall (17” I would guess) and a DirecTV box that gets all DTV channels including HBO and Cinemax (but not ShowTime).

There’s a hospital gown on the bed, a pair of paper underwear (!) and a box of stockings. The last, I’ve read, is necessary to help prevent blood clots during surgery. I’m instructed to change into the underwear and gown and then open the door. Minutes after I do so, a nurse appears to help me with the stockings. She’s a short, plump woman who speaks very little English, and turns out to be wonderfully, warm, caring, affectionate and maternal. She struggles mightily getting the stockings on my legs and, having never worn anything remotely similar, I can do little to help. Finally, they’re on

In the next 30 minutes, a small parade of doctors visit my room. They’re all there to see if I have any questions, to tell my about the procedure, but mostly to reassure me, I think. And they do that wonderfully. I have done so much research on the internet and have already asked every possible question I can think of, that there’s nothing left to for me to ask at this point.

I think the doctors are arriving in order of seniority, and the second last to arrive is Dr. Hernandez. I can’t say exactly why, but this man exudes to me such a calm sense of total competence that the little bit of trust that had eroded the previous day has returned by the time he left my room. He is exceedingly warm, friendly and conversational. He tells me a little bit about the procedure, but senses immediately that I already have most of that information. But it’s a testament to his perception that he still gets me to discuss a couple of minor concerns I didn’t even know I still had.

He tells me that I’ll probably be in the operating room for 40 to 50 minutes, but the surgery will take only about 20 to 25 minutes. They only have three surgeries lined up for that day, so it should be a light day for them, since they often do 5 or 6 each day. (During rounds the next day, almost all the doctors have had a haircut and while they compare their cuts, I realize that it’s not so frequent that they have a light day.)

And then Dr. Ortiz arrives. Strangely, we both immediately had the sense that we have met before, but we just can’t figure out where, or even if we really have. My impression of him is that of a kid who needs, but has missed his daily dose of Ritalin. He’s all hyper and full of energy. He can hardly keep still, but exudes a sense of total confidence. Once again, there’s really little to talk about, so we end up discussing a couple of his competitors I had researched. He’s standing at the door, notices someone in the corridor, says he’ll be back in a minute and I never see him again.

I’ve been mildly nervous and faintly needing to urinate for some time, but I know it’s the nerves and want to wait until just before the surgery. I have a fear that as soon as they take me into the ER, I’ll ask to hop off the operating table to go pee. Dr. Hernandez echoes my thoughts. He suggests I wait to go to the bathroom just before I’m taken to the ER. Because it’s such a short surgery, they won’t be using a catheter.

A moment later the nurse arrives and asks if I’d like to go to the bathroom. Sure, I say. She leads me there and when I come out, she’s waiting for me. I think we’re going back to my room, but she leads me to the OR.

NoWorry · 05-22-2007, 07:07 PM

Inside the OR, it’s all shiny and spotless. I barely have time to look around while I’m being led to the operating table. As soon as I lie down, a nurse is fastening a blood pressure cuff around my arm and the anesthetist is hooking me up to the IV (the needle has already been put in my hand earlier, during the doctor visits). And less than 2 minutes after I’ve entered the OR, my lights go out.

I have a few fuzzy memories that may be real or perhaps I made them up. I think I have a very vague recollection of being lifted from the operating table to my gurney/bed. And maybe I remember being wheeled into my room. I’d already set up my CPAP machine before the surgery and the mask is somewhere near my head. I remember having the thought that I really should put it on, but I can’t convince my body to actually do it. I drift in and out for a while, but I really have no sense of time.

The next thing I know, the nurse is standing beside my bed and gently waking me up. She checks my pulse, my blood pressure and my temperature. And then she tells me it’s time to walk. She rolls my IV stand around and hovers close as I climb out of bed. She holds my hand and we start to walk around the corridor. There are two doors on the circular circuit through the clinic and she opens the doors for me while wheeling my IV stand and keeping it out of my way. I do two laps and I can see her level of alertness tapering off, which I am delighted to see, since I know it means I’m doing well.

When I’m back in my room, the nurse tells me to sit in the chair rather than get back into bed. Although it’s well upholstered, she puts a pillow on the seat and an extra cushion for my back. It’s small touches like that, throughout my entire stay at the clinic, most of which I don’t remember, that gives me a great sense of security and being well looked after. She hands me the remote call button and the TV remote and leaves. The level of attention is so high that the remote call button is never farther than my reach – and I do not have the need to use it a single time.

The nurse brings me a cup of ice chips and I suck on them greedily. My own care kit includes Chloraseptic throat strips as well as Hall’s throat lozenges because I had read the comments of some patients who complained of a sore throat following surgery because of the itubation during surgery. However, I really have no need for either, but I keep them out in case the need arises.

I grab the telephone and call all the friends and family members I have promised to notify immediately following the surgery and talking to each of them is like a warm hug. The clinic’s phones have direct dialing all over the US and the calls are all complimentary. The paper underwear is driving me nuts, so I change into my regular underwear. Shhh.

Most of the remainder of the day is really uneventful. I watch a lot of TV. I get up and walk a total of three more times. (My research had indicated a very direct correlation between walking and gas pains – the patients who walk the most, reported the least gas pains.) I dig into the care kit that I had brought and take a couple of Gas-X strips a couple of times during the afternoon and evening. I’m not certain if they help or not, but they certainly do no harm.

Pain medication is brought to me a few times. I think I got a cup of hot chicken broth once (or maybe it was twice). But the most important thing is that I am always entirely comfortable and always know that assistance, if I need it, is very close at hand. At around 8 o’clock, I think, another doctor arrives and introduces himself. He’s going to be available all night and if I need anything he will be at hand. Neither I nor any of my two fellow patients had any need to see him as far as I know,

As a result of a discussion in the Sleep Apnea thread on an online forum, I have brought a heating pad with me. Some patients had reported that they found it uncomfortable to sleep on their side following surgery, and ever since I started wearing my CPAP mask, I’ve been unable to sleep on my back. One post suggested a heating pad might relieve some discomfort and I hold mine to my stomach as I turn on to my side. I can’t be certain that the pad helps, but I have absolutely no trouble sleeping on my side.

At 4:00 a.m. I turn over in my sleep to switch sides and am immediately awakened. It isn’t pain, or even discomfort, just an awareness that something is different inside me. I decide I’ll get up and take a pee since I’m already up. When I come out of the bathroom, the night nurse is waiting for me with a blue-tinted flash light. She asks if I’m okay. I am. She asks if I need some pain medication. I consider it, but decline. I’m really not hurting.

I go back to my room, get back into bed and go right back to sleep.

NoWorry · 05-22-2007, 07:07 PM

The next thing I know, it’s morning and the nurse is waking me up with a cup of broth. And pain meds. Since these are routine meds, I dutifully put them under my tongue and let them dissolve .

I walk a little, I spend some time on one of the clinic’s two computer stations, checking email. I actually check my investment portfolio. I find an interesting stock and even enter a stock trade. Discharge is fairly quick and painless, and when I’m seated in the lobby, waiting for Mrs. Ortiz to arrive and drive me and my fellow patients back to the hotel, I am comfortable, pain- and discomfort-free and delighted to have the entire surgery behind me. Along with my paperwork, I’m given a little box containing 4 Taradols – the pain killers that dissolve under my tongue and give me instant pain relief. I’m sure they’re not enough, so later that day, I find a pharmacy and buy 12 more. Turns out I don’t even take all 4 that were given to me.

At no time during the entire process do I ever feel any real pain. There are times when I feel discomfort and maybe once or twice the discomfort is fairly elevated. Once I turn quickly at an awkward angle and feel a brief, sharp pang, but it is gone in a few minutes. And I wake up once or twice the following night in my hotel room whenever I turn in my sleep. But it is a mild discomfort and each time I go right back to sleep. By comparison, I twisted my ankle about a month ago and the pain and discomfort during the following days was more than that from this surgery.

Mrs. Ortiz arrives and escorts me and my fellow patients to her car in the underground garage. I, of course, have all my luggage with me – a small suitcase, plus my CPAP bag. My fellow patients also have their overnight bags with them. Mrs. Ortiz is a tiny lady. I’m sure she couldn’t tip the scales over 100 lbs fully dressed and sopping wet. So clearly she’s not a candidate for lifting luggage into her trunk.

My research has indicated that it’s ill-advised for bariatric patients to lift more than 10 lbs for at least a couple of days following surgery. But here we are with no alternative but to load our own luggage into the trunk of the Volvo. Later that day, I notice the transportation from the Obesity GoodBye clinic pull up outside our hotel. It’s a snappy brown van with the corporate logo painted on the side. A uniformed driver bustles around making sure that his patient passengers don’t have to lift a thing and even offering them assistance climbing out of the van.

In contrast, Mrs. Ortiz stops outside the hotel, sits patiently in the driver’s seat while we climb out and unload our luggage, and drives away without a word. My fellow patient tells me that the previous day, at 5 p.m. - the end of visiting hours – her companion was put in a cab for the ride back to the hotel at her own expense. Tacky. How can an organization with such professional and impressive conduct inside the clinic be so terribly inept on an administrative level?

I go to the front desk to re-check in, give the receptionist my name and she looks at me in surprise. I’m just returning to my room, right, she asks? Not checking in again? I confess that I don’t know. Sure, she says, my room’s still waiting for me. Just drag your bags up there again. Nah, I’m kidding. The porter takes my bags up for me.

NoWorry · 05-22-2007, 07:08 PM

I have a hot, hot shower and examine my surgical incisions. The four small cuts are actually rather tiny. I’ve seen insect bites that are almost as big. The center incision, where the port was inserted is bigger – a little more than an inch. They’re all coated with a surgical glue which, I’m told, will wash and wear off over a few days by the time the skin has sealed itself together. No stitches. Cool.

We have been encouraged to walk. The more the better. Most women patients take a cab to Revolucion Ave and walk its 5-block length full of stores catering to tourists. I’ve found a map of the city, and I’m an adventurous spirit. I decide I’m going to walk there. It’s an adventure. I avoid the main thoroughfares and take the lesser streets. I love watching the locals going about their business, the real stores and restaurants and the ‘real’ Tijuana. It takes 40 minutes to get to Revolucion Ave. Another 20 minutes to walk its length and back. For me, who hates shopping, it’s more of a duty than a pleasure. I get it over with and grab a taxi back to the hotel.

I spend most of the day in my room, watching TV. There’s basic cable here and a few movie channels, but the lineup is poor. I talked myself out of bringing my portable DVD player and a few choice movies because of the weight, but now I regret the decision.

However, I have brought a couple of juice boxes (12 actually, but I shame-facedly leave 11 in the hotel room), which makes a great lunch. I have also brought a small jar of powdered chicken broth, and that evening, I use the coffee maker to heat water to make myself a cup of broth for dinner.

At a few minutes before 5, I suddenly realize that I have no idea what the travel arrangements are for my drive to the San Diego airport the following day. My flight isn’t until 1:30 p.m., but I don’t have enough confidence in the OCC’s admin group, to believe that everything will be looked after.

Now, of course, I can’t call from my hotel room, because the call costs 50 cents and I haven’t left a card with reception to pay for incidentals. So I scurry down to the front desk, give them a credit card, and then rush back to my room to make the call.

I get Claudia and she’s exactly the person I want to talk to. She offers to put me through to Alexander who makes these arrangements, but I think I know enough now to stick with the people I know I trust. I ask Claudia if she’ll take care of the details for me. Always professional, always agreeable, she puts me on hold for a few moments and then comes back to tell me that my pick up will be at 10 a.m. the following morning. It feels a bit early, but I’ve already been advised on the discussion groups to bring a lot of reading material for exactly this eventuality.

I go out for a walk and stroll past a McDonalds, a Wendy’s and a Carl’s Jr (my absolute favorite). Rather than tempted, I feel empowered.

When I return to my room, it’s 8:00 and the phone is ringing. I rush to grab it. It’s Mrs. Ortiz calling to give me my pick up information for the following morning. I don’t tell her that I already know. I listen dutifully. To my surprise, she takes a moment extra to thank me for placing my trust in her organization. And encourages me to tell my friends about them.

I put a Taradol under my tongue, letting it dissolve while I change into my PJ’s and go to bed. I wake briefly twice during the night, but each time go right back to sleep.

NoWorry · 05-22-2007, 07:09 PM

The next morning, I bathe and pack my stuff. I check out and settle up the 50 cents I owe for the call to the Clinic. I’m a few minutes early, so I sit at the computer and check my email. A few minutes later, the bellman summons me over; my ride has arrived.

I go to the front door and look for the scruffy white van. Not in sight. The entry is being blocked by a shiny, brown van. On the door is a decal with the OCC logo. There’s a tall, neat man beside the van wearing dress pants and a striped polo shirt. He introduces himself as Francesco, holds my door open for me and helps me climb in. The interior is clean and comfortable. There’s even a portable DVD machine hooked up for viewing.

As far as I can tell, there were multiple trips schedules from the airport on Tuesday when I arrived, and they used a commercial driver to pick me up. And started my bariatric journey on a terribly sour note instead of the calm, peaceful one the luckier patients enjoyed.

Depending on traffic, it can take anywhere from ½ to 2 hours to cross the border. Due to regulations, commercial vehicles like OCC’s must use the Bus lane and it moves very slowly. On my trip, it took us around 45 minutes to get to the Immigration hall where all passengers must off-load with all their bags and be processed though immigration in the hall. Francesco had told me exactly where to meet him on the other side and he was waiting for me when I got through about 10 minutes later.

Another 15 minutes to the San Diego airport and I was off the van and checking in at 11:15 for my 1:30 flight. But I did not mind. My surgery was done. I was starting a new life and I was on my way back home. Life is sweet!

NoWorry · 05-22-2007, 07:22 PM

I feel that, in the process of information gathering, a number of promises were implicitly made by OCC. Some were kept, others were broken.

A comfortable ride from San Diego to Tijuana BROKEN
A complete pre-op work over KEPT
A valuable personalized consultation with a nutritionist BROKEN
A patient facilitator to simplify all interactions BROKEN
A comfortable room at a 5-star hotel KEPT
… for 3 nights BROKEN
Meetings with my surgery team KEPT
Efficient and effective bariatric surgery KEPT
Excellent recuperative nursing care KEPT
A comfortable ride from Tijuana to San Diego KEPT

alysedg23 · 05-23-2007, 08:25 PM

Wow, I cannot believe that you took the time to write a detailed play by play account of your trip...

Thank you so much for doing that, for those of us about to take that journey we can go in with some knowing and expectations...

jvalve · 05-23-2007, 10:16 PM

thanks for the great information!