Re: Dr. K goes Laparoscopic (Nick)

[Guest guest]

> I therefore see NO reason why Dr. K's learning curve for the

> lap DS would be any shorter than that of any other doctor.

Except that Dr. K has the advantage of not being the FIRST lap

DS surgeon. Almost all of the other lap DS surgeons have

published reports on their learning curves and procedures. I am

assuming that Dr. K is at least on speaking terms with these

other surgeons and is aware of this. Therefore, he is aware of

the mistakes and/or complications they had and the solutions

they developed. This is not to say that he would not have a

learning curve, only that he has the advantage of knowing what

other surgeons went through. Presumably, he could therefore

be proactive in avoiding some of the lap-related complications

other surgeons experienced.

-

(not a Dr. K patient, if only for geographical reasons)

[Guest guest]

> I therefore see NO reason why Dr. K's learning curve for the

> lap DS would be any shorter than that of any other doctor.

Except that Dr. K has the advantage of not being the FIRST lap

DS surgeon. Almost all of the other lap DS surgeons have

published reports on their learning curves and procedures. I am

assuming that Dr. K is at least on speaking terms with these

other surgeons and is aware of this. Therefore, he is aware of

the mistakes and/or complications they had and the solutions

they developed. This is not to say that he would not have a

learning curve, only that he has the advantage of knowing what

other surgeons went through. Presumably, he could therefore

be proactive in avoiding some of the lap-related complications

other surgeons experienced.

-

(not a Dr. K patient, if only for geographical reasons)

[Guest guest]

Just some comments -

----- Original Message -----

> Bottom line: If you hop up on Dr. K's table for a lap DS right now,

> you are volunteering for an experimental surgery by a surgeon who is

> not experienced in performing it.

What kind of experiment?

> My advice, give him a hundred or so Lap DS's to work the kinks out

> before signing up for it.

> Tom

Tom, who should he do these 100 lap DSs on?

- SC

[Guest guest]

Just some comments -

----- Original Message -----

> Bottom line: If you hop up on Dr. K's table for a lap DS right now,

> you are volunteering for an experimental surgery by a surgeon who is

> not experienced in performing it.

What kind of experiment?

> My advice, give him a hundred or so Lap DS's to work the kinks out

> before signing up for it.

> Tom

Tom, who should he do these 100 lap DSs on?

- SC

[Guest guest]

Wow, Tom, when you're sure you're right, you're absolutely sure that

you're right, no matter where the truth may lie.

My comments, notwithstanding your solid stance, stand. Dr. K's

background in lap surgery is significant in spite of your lame

analogy to " training wheels " and the suggestion that all surgeons are

lap surgeons.

To continue your analogy from yesterday, when you learn with training

wheels and you take them off when you are ready to go it alone and

you can proceed solo just fine. If you get on a bike for the first

time without having had the benefit of training wheels, you do as I

did, crash into a rose bush - or whatever the closest obstacle might

be.

By the way, you made some comments about Delano Regional Medical

Center that I should have responded to in greater detail. If you

were to research fact, instead of dearly clinging to your opinion,

you would find that Dr. Keshishian has at his disposal the newest and

best of everything - from the operating room to the newly created

wing for bariatric surgery patients. Is that really available at USC?

Let's not let this degenerate into further " My Daddy is bigger than

your Daddy " exchanges.

Best-

Nick in Sage

[Guest guest]

Wow, Tom, when you're sure you're right, you're absolutely sure that

you're right, no matter where the truth may lie.

My comments, notwithstanding your solid stance, stand. Dr. K's

background in lap surgery is significant in spite of your lame

analogy to " training wheels " and the suggestion that all surgeons are

lap surgeons.

To continue your analogy from yesterday, when you learn with training

wheels and you take them off when you are ready to go it alone and

you can proceed solo just fine. If you get on a bike for the first

time without having had the benefit of training wheels, you do as I

did, crash into a rose bush - or whatever the closest obstacle might

be.

By the way, you made some comments about Delano Regional Medical

Center that I should have responded to in greater detail. If you

were to research fact, instead of dearly clinging to your opinion,

you would find that Dr. Keshishian has at his disposal the newest and

best of everything - from the operating room to the newly created

wing for bariatric surgery patients. Is that really available at USC?

Let's not let this degenerate into further " My Daddy is bigger than

your Daddy " exchanges.

Best-

Nick in Sage

[Guest guest]

> > My advice, give him a hundred or so

> > Lap DS's to work the kinks out

> > before signing up for it.

>

> Tom, who should he do these 100 lap DSs on?

Not me or any of my loved ones, that's for sure!

[Guest guest]

> > My advice, give him a hundred or so

> > Lap DS's to work the kinks out

> > before signing up for it.

>

> Tom, who should he do these 100 lap DSs on?

Not me or any of my loved ones, that's for sure!

[Guest guest]

Hi Nick:

> Wow, Tom, when you're sure you're right, you're

> absolutely sure that you're right, no matter

> where the truth may lie.

Something we have in common, me thinks...

>

> Dr. K's background in lap surgery is significant

> in spite of your lame analogy to " training wheels "

Okay, so my analogy was lame. I'll try a different one -- student

pilots. Advanced student pilots learn to fly in a somewhat similar

fashion to how advanced student surgeons, (residents with the

requisite experience watching operations and practicing on cadevers,

or whatever they use these days), learn to operate.

The student pilot flys the plane, but the instructor pilot is always

right there, ready to take over if anything goes wrong with the

flight. Similarly, the resident performs the surgery, but the

professor is right there to take over in case anything goes wrong

with the surgery.

Going back once again to our soon-to-be pilot... No matter how many

flights s/he makes with the instructor, they are still student

flights. The pressure just isn't the same. Sure, if the student

pilot messes up badly, he may get tossed from the program and never

become a pilot, and we can all safely assume that the student pilot

would avoid this if his/her skills allow her/him to do so.

But the pressure gets worse when the instructor pilot is no longer

there and the student must fly " solo " -- now there is no one to keep

the Grim Reaper from taking the controls except for our newbie

pilot. Similarly, once the surgeon finishes her/his residency, there

is no longer a wise professor in the room to help keep the Grim

Reaper from taking the patient.

The pressure is now higher, and it is all on the new surgeon. This

is real, without a net, surgery. And this is why I don't count

surgeries performed during residency when figuring a surgeon's

experience.

> and the suggestion that all surgeons are lap surgeons.

I didn't suggest that all surgeons are lap surgeons any more than all

dancers are lap dancers. You implied that Dr. K has more experience

with lap surgery than most other surgeons who have recently completed

residency. I quoted from the standards of the American Board of

Surgery, (the certifying body for surgeons in the United States), to

the effect that ALL surgeons MUST be trained in laparoscopic surgery

in order to become " Board Certified " as general surgeons.

If you have some evidence to show that during his residency Dr. K

performed say, 2X laparoscopic procedures while most other surgeons

perform only X laproscopic procedures during their residencies, then

please, enlighten me. (I would still consider them " practice "

surgeries, for the reasons stated above, but at least I'd know that

Dr. K had indeed performed more such practice procedures than

average.)

> Let's not let this degenerate into further " My Daddy is bigger than

> your Daddy " exchanges.

I really don't see what my dad has to do with this. (He's only 5'5 "

tall, by the way, and his is the THIN side of the family.)

For the record, Dr. Anthone, (who is NOT my father, but who isn't a

great deal taller than my father), has performed more than 500 DS

surgeries, (without an instructor pilot). In addition, I estimate

that he has probably performed something on the order of 1,600 to

3,000 total surgical procedures since he finished his residency and

the two-year surgical fellowship that followed. (That's 4-6

procedures per week, 40-50 weeks per year, since 1991.) He also

TEACHES laparoscopic surgery to residents in his capacity as a

professor of surgery.

But, if Dr. Anthone were to begin performing the DS laparoscopically,

I would advise folks to wait until he had performed a hundred or so

before signing up for one, just to let him work the kinks out. It

has nothing to do with who has the meaner dad or the longer ...

um ... probe. It's simply a matter of being prudent in a matter of

life and death.

Cheers,

Tom

[Guest guest]

At the risk of getting caught in the crossfire...j/k, I'd like to say

I chose Dr K for the following reasons: How he values me as a

patient, my research, my time frame and my wallet.

Dr's A, R and K are all competent surgeons, I don't think that's been

the point of the debate, if I've read the lines and between the lines

correctly.

Which one would get chosen if all things were equal? Personally, for

me, it would have been Dr. Rabkin, since he is closer to my home, I

have a personal reference and he's a world renowned surgeon (I've

heard). The fact of the matter is, he didn't seem to want to be MY

surgeon. I'm not sure how else to take the fact that it took me a

month with working (very patiently) with his office to get my

insurance ALMOST checked. I felt like he could be the best surgeon

in the galaxy this side of Bones McCoy, but if he didn't value my

business (for whatever the reason), I needed to take my business

elsewhere. I also felt that his request for upfront fees was telling

me that he preferred to work with self pay patients. No problem, I

understood.

Then, I turned to Dr. K, who was much closer than Anthone, and within

my budget for the aftercare. My insurance is covering all but $100,

so the aftercare and hotel prices were all that I had to be concerned

with. I didn't try Anthone, because I assumed (possibly erroneously)

that he would have much the same backlog as Dr R.

Dr. K is young, yes. He is, relative to the others, inexperienced.

He is just starting lap procedures. Would I want to be the first

batch? Nope. Would I be his 20th? Probably. Would I be his 50th?

Absolutely. The point for ME was clear. I would prefer open now, to

lap later. I feel that being MO is damaging my health more by the

hour. I don't want to wait while someone " fits me in " to their

schedule, because they are so inundated with patients that their

staff can't even return a phone call.

Delano is, pretty much, the middle of nowhere. What an ingenious

idea for a surgeon just starting out to place his shingle where there

isn't such a high overhead, and is a little more remote. Someone

said earlier, if you build it, they will come. As you can see from

the number of posts regarding him, the number of patients seeking his

care is only increasing. I believe that a lot of that has to do with

his accessability, but it also has to do with his successability (my

own word).

It is also due to his concern and openness to the patient and the

process. I watched him, during a seminar, get beat down about the

charges for self pays (even though his fees are less than either R or

A), and he handled it all with aplomb. He is interested in his

patients, and in their histories. He did not leave a stone unturned

with me, and I see that as competence. That's all I want, a

competent Dr. He doesn't have to be Barry Bonds, what I want is Will

or Tony Gwynn. (No, not literally, silly!) I'm sure the

superstars are the only way to go for a lot of people, but not for

me. (My prediction...Dr K a superstar within 2 years!)

I know from experience that it is hard to run a medical office when

business is booming. I also know from being in the customer service

field that the chances of you getting better care AFTER your

first " purchase " are less if the care you received before

your " purchase " was less than satisfactory.

The truth (manifesto, sorry)according to

(beautiful butterfly in waiting)

Dr. K

8/24/01 THIS FRIDAY!!!!!!

>

> Hi Nick:

>

> > Wow, Tom, when you're sure you're right, you're

> > absolutely sure that you're right, no matter

> > where the truth may lie.

>

> Something we have in common, me thinks...

>

> >

> > Dr. K's background in lap surgery is significant

> > in spite of your lame analogy to " training wheels "

>

> Okay, so my analogy was lame. I'll try a different one -- student

> pilots. Advanced student pilots learn to fly in a somewhat similar

> fashion to how advanced student surgeons, (residents with the

> requisite experience watching operations and practicing on

cadevers,

> or whatever they use these days), learn to operate.

>

> The student pilot flys the plane, but the instructor pilot is

always

> right there, ready to take over if anything goes wrong with the

> flight. Similarly, the resident performs the surgery, but the

> professor is right there to take over in case anything goes wrong

> with the surgery.

>

> Going back once again to our soon-to-be pilot... No matter how

many

> flights s/he makes with the instructor, they are still student

> flights. The pressure just isn't the same. Sure, if the student

> pilot messes up badly, he may get tossed from the program and never

> become a pilot, and we can all safely assume that the student pilot

> would avoid this if his/her skills allow her/him to do so.

>

> But the pressure gets worse when the instructor pilot is no longer

> there and the student must fly " solo " -- now there is no one to

keep

> the Grim Reaper from taking the controls except for our newbie

> pilot. Similarly, once the surgeon finishes her/his residency,

there

> is no longer a wise professor in the room to help keep the Grim

> Reaper from taking the patient.

>

> The pressure is now higher, and it is all on the new surgeon. This

> is real, without a net, surgery. And this is why I don't count

> surgeries performed during residency when figuring a surgeon's

> experience.

>

>

> > and the suggestion that all surgeons are lap surgeons.

>

> I didn't suggest that all surgeons are lap surgeons any more than

all

> dancers are lap dancers. You implied that Dr. K has more

experience

> with lap surgery than most other surgeons who have recently

completed

> residency. I quoted from the standards of the American Board of

> Surgery, (the certifying body for surgeons in the United States),

to

> the effect that ALL surgeons MUST be trained in laparoscopic

surgery

> in order to become " Board Certified " as general surgeons.

>

> If you have some evidence to show that during his residency Dr. K

> performed say, 2X laparoscopic procedures while most other surgeons

> perform only X laproscopic procedures during their residencies,

then

> please, enlighten me. (I would still consider them " practice "

> surgeries, for the reasons stated above, but at least I'd know that

> Dr. K had indeed performed more such practice procedures than

> average.)

>

>

> > Let's not let this degenerate into further " My Daddy is bigger

than

> > your Daddy " exchanges.

>

> I really don't see what my dad has to do with this. (He's only

5'5 "

> tall, by the way, and his is the THIN side of the family.)

>

> For the record, Dr. Anthone, (who is NOT my father, but who isn't a

> great deal taller than my father), has performed more than 500 DS

> surgeries, (without an instructor pilot). In addition, I estimate

> that he has probably performed something on the order of 1,600 to

> 3,000 total surgical procedures since he finished his residency and

> the two-year surgical fellowship that followed. (That's 4-6

> procedures per week, 40-50 weeks per year, since 1991.) He also

> TEACHES laparoscopic surgery to residents in his capacity as a

> professor of surgery.

>

> But, if Dr. Anthone were to begin performing the DS

laparoscopically,

> I would advise folks to wait until he had performed a hundred or so

> before signing up for one, just to let him work the kinks out. It

> has nothing to do with who has the meaner dad or the longer ...

> um ... probe. It's simply a matter of being prudent in a matter of

> life and death.

>

> Cheers,

>

> Tom

[Guest guest]

What the patient risks in having a surgeon with a limited number of

laps under his/her belt is a higher risk of complications. It's a

risk, not a guarantee. And with adequate experience the risks are

equal to that of the open.

I passed up an open in November last year because I wanted the lap.

When the lap option was lost and my insurance was running out I had

the open. No regrets. However, I am researching lap options for my

significant other.

What I don't know is the nature and severity of the increased

complications during the learning curve of 70 procedures. Maybe that

information is buried in the stack of articles and abstracts that I

have been slowly sorting through.

I think the notion of avoiding a surgeon until they have 100 laps is

hugely excessive.

in Seattle

> Bottom line: If you hop up on Dr. K's table for a lap DS right

now,

> you are volunteering for an experimental surgery by a surgeon who

is

> not experienced in performing it.

>

> My advice, give him a hundred or so Lap DS's to work the kinks out

> before signing up for it.

>

> Tom

[Guest guest]

And your scars are so cute, to boot!

> > I think the notion of avoiding a surgeon until they have 100

laps is

> > hugely excessive.

>

> I was Dr. Rabkin's 2nd fully lap DS patient. I had great

confidence in

> his lap skills though; his extensive lap experience dated back

several

> decades, being a pioneer of the lap cholecystectomy in

California. When

> I had my initial consult and got my surgery date, I thought I

would be

> getting open DS, and was fine with that! As luck would have it

though,

> he adopted the LapDS during my wait, and I was one of the

first of his

> patients to get it. No regrets here!

>

> M.

>

> ---

> in Valrico, FL, age 39

> Starting weight 299, now 156

> Starting BMI 49.7, now 26.0

> Lap DGB/DS by Dr. Rabkin 10-19-99

> http://www.duodenalswitch.com

>

> Direct replies: mailto:melanie@t...

>

>

>

__________________________________________________

_______

>

[Guest guest]

I am not a doctor and I don't play one on TV, but it seems to me that

the worse case during a lap procedure would be 'Oopsie - guess we

gotta go open', and you wake up with a longer incision than expected.

Just a thought.

Greg