FREQUENTLY ASKED QUESTIONS

A FEW QUESTIONS REGARDING WEIGHT LOSS SURGERY:

Where do you do the weight loss surgery and Adjustments?
Dr. Armando Joya is based out of Puerto Vallarta Jalisco Mexico. He does not practice in the United States and is solely licensed in Mexico as a surgeon and Gastroenterologist.  He is the leading surgeons for Band, Bypass, and Gastric Sleeve Surgery in all of Jalisco.  He was the very first doctor to do a Gastric Sleeve surgery in Mexico. He works at one of Mexico's finest Hospital's San Javier and also the Cornerstone Hospital. He will only do surgery in Puerto Vallarta because of the quality of the hospitals.  Dr. Joya offers free adjustments to his patients only in Puerto Vallarta at his medical office.  There is a nominal fee for the Xray machine if the fill is done at the hospital in Puerto Vallarta.

What is Bariatric or weight loss surgery?
Bariatric surgery is the area of surgery that focuses on operations to reduce weight and treat obesity. The name comes from the Greek words baros, meaning weight, and iatrike, meaning treatment.

How is weight loss surgery different than liposuction?
Weight Loss Surgery is major surgery involving the gastrointestinal tract. The stomach and intestines are modified so that less food can be consumed or absorbed, which leads to a substantial loss of weight that can be maintained for years. Liposuction is a form of cosmetic surgery in which areas of the body are reshaped or resculpted by removing excess amounts of fat in those areas. The purpose of liposuction is not to produce weight loss.

How do I know if I'm a candidate for this surgery?
Dr. Joya advises that you must have clinically severe obesity, also known as morbid obesity. This means your BMI must be higher than 35, or you must be at least 100 lbs above your ideal body weight. You may be a candidate if you're less than 100 pounds overweight, if you also have significant health problems due to your weight, such as Type 2 diabetes. Most people with clinically severe obesity are good candidates for surgical treatment-as long as you understand the procedure, don't have a severe, pathological eating disorder and are willing to come back for follow-ups.

What is BMI?
It stands for Body Mass Index and it determines someone's health risk related to their weight. A BMI greater than 40 or greater than 35 with associated medical problems means you have clinically severe obesity which is associated with diabetes, heart disease, high blood pressure, high cholesterol, heartburn, gallstones, arthritis, urinary stress incontinence, infertility, and some types of cancer.

Does my weight alone justify such extreme measures?
Yes. Morbid obesity is an independent risk factor for premature death, with the risk rising as the BMI increases. People with a BMI of 30 have a relative risk of dying early that is 1.3 times greater than normal weight individuals. By the time the BMI is 40, the risk is close to 3 times as great.

I feel so guilty about being obese. . . is it all my fault?
No, obesity tends to run in families. Identification of several genes and their corresponding hormones (leptin) have been found to be at least partially responsible for obesity. Therefore, there is evidence that obesity is at least partially biological, helping to reduce the misconception that it is a behavioral or psychological disorder. I consider obesity a disease which needs a cure, rather than a moral failing which is the fault of the individual.

Why should I consider WLS?
Because it works! Surgical treatment for obesity is the ONLY treatment that reliably produces significant and sustained weight loss. People with clinically severe obesity are at great risk for developing many associated medical conditions. Research has shown that surgical treatment results in significant weight loss and improvement in most problems associated with obesity. Surgical treatment for clinically severe obesity has been endorsed by the National Institutes of Health, the World Health Organization, Shape-Up America, the American Heart Association, the American Dietetic Association, and the American Obesity Association.

Why not just lose the weight through diet and exercise and skip the serious complications that could result from surgery?
If you can lose the necessary amount of weight (and keep it off) though diet and exercise-more power to you! Ninety five percent of the people considering WLS have tried (sometimes numerous times) and failed.

Why not take drugs to combat obesity?
Drug treatment does produce limited success (usually weight loss of about 35 to 40 pounds). However, concerns about safety of long-term treatment have limited the drugs available and the length of time people can take them. This in turn, limits their effectiveness because, as with any chronic disease, such as diabetes or high blood pressure, the drug is only effective as long as it is taken.

How this WLS promote weight loss?
Operations for the treatment of obesity usually induce weight loss by limiting the amount of food consumed, altering the normal absorption of nutrients, and/or altering the way the body utilizes energy. A Band Surgery or Gastric bypass does all three. They actually boost your metabolism for the first 18 months, which is one reason patients lose weight so quickly.

Is it unhealthy to lose weight rapidly after WLS?
I like to answer this question by asking another question: "Is it healthy to be 100 pounds overweight?" The rapid weight loss experienced after WLS is extremely gratifying psychologically and physically. If you eat properly, making sure you get enough protein, there should be no ill effects from it.

Is there any limit on how heavy one can be to have weight loss surgery?
No. Successfully operations have been done on patients who weighed 750lbs., who had a BMI of 100. The operative risks are higher the more you weigh, but they still don't approach the risk of remaining at such a high weight. I personally have operated on one gentleman who weighed over 500 pounds and we were still able to fit the Swedish Band on him.

How much weight can one expect to lose after surgery?
Most patients lose between 50 and 70% of their excess body weight over about 1-1 ½ years. Some reach their ideal weight, but some don't.

How long does it take to perform the operation?
The Laparoscopic Band Surgery takes less than 30 minutes, and the Gastric Bypass usually takes between 2 and 4 hours, depending on the surgery and complications. The Gastric Sleeve Surgery, takes about 1 hour. The BIB Balloon procedure can be done in about 20 minutes.

Does it matter how long it takes?
The length of the operating procedure may make a difference. Many studies have documented an increase in the incidence of infectious complications, such as pneumonia and wound infection, after prolonged surgical procedures. Longer operations result in a fall in body temperature that interferes with the immune system. In addition, longer operative times mean increased exposure to general anesthesia, which often results in the collapse of portions of the lung and can lead to pneumonia. In general, shorter operations are safer.

How long will I be in the hospital? How long does it take to recuperate?
Most BAND patients are admitted to the hospital in the afternoon of their arrival to Puerto Vallarta, which can be any day of the week, around 3:00 pm. Dr. Curiel, the Internist and the Anesthesiologist then can run tests on you while you are in the Hospital, get the results to Dr. Joya who then will  prepare for surgery around 6:00 pm that very evening. You then will remain in the hospital for 1 night, and ultimately move to the Krystal Hotel, a 5 star hotel located across from the hospital. You will then be free to go home the next day. You may experience slight discomfort, but many patients have been able to go to work the very next day after returning from the surgery. The Laparoscopic Gastric Bypass Surgery follows a similar process where you will enter the hospital the day of your arrival, but will stay 3-4 night in the hospital and then move to the Krystal Hotel. Your recovery usually requires between 2 and 6 weeks to recuperate before returning to work, depending upon the type of job you have, but you will be able to leave Vallarta 10 days after your surgery. The Gastric Sleeve surgery requires 2 nights in the hospital and 3 in the hotel and the recovery time is similar to that of the Gastric Bypass. The BIB Balloon procedure allows you to return to work the very next day.

A year after the surgery, are most people generally happier with their lives?
Yes. Much happier. Most patients say they would do it again "in a heartbeat." Studies show that this kind of patient satisfaction is a true test of the surgery.

When it's over, will there be things I need to do after surgery?
Regular, follow-ups are needed to monitor weight loss, provide dietary counseling, and to monitor for the occurrence of nutritional deficiencies or complications. Also you will need to have your Band Adjusted (or "filled') every few months. Dr. Joya or one of his associates will be available in either Puerto Vallarta for your adjustments and follow up appointments. Dr. Joya also recommends that you get an Upper GI done at least once a year for the first few years to ensure that the band is fine.

Can someone be too young to be a candidate for this surgery?
Yes. People can be too young. You need to have stopped growing and you need to have a mature bone age. In addition, you must understand the surgery and want it. You can't have an operation because your friends or your parents want you to. You need to be able to give "informed consent", which means you make an educated decision and then give your permission for the procedure. It is also necessary that your parents are supportive of your decision and understand the role they will need to play in your care and recovery.

Can you be too old for this surgery?
Age is one factor that needs to be considered together with all other aspects of a person's health. I would not give an arbitrary or absolute cut off. Surgeries have been done on several patients in their late 60s and early 70s, with excellent results.

I am severely overweight, have diabetes, hypertension, and congestive heart failure. My internist tells me that I am "too sick" to be a candidate for WLS.
If you are overweight with associated problems due to obesity, you are not too sick not to have this operation! You are too sick NOT to have it. The only chance you have for improvement in your medical conditions is through weight loss surgery.

METABOLIC SURGERY SPECIFIC

1. What are the requirements to qualify for the surgery?

- If you are under 55 with a BMI of 28 or higher, and have been taking insulin and a diabetic for less than 3 years Dr. Joya says that you qualify for this procedure.

GASTRIC SLEEVE SPECIFIC

1. Why does Dr. Joya use a drain when other doctors do not?

- The drain according to Dr. Joya is very important to show whether or not there is a leak post op.  The drain is usually used by experienced surgeons and at a minimum is a backup to let you know if a leak exists.

2. How does Dr. Joya check for leaks?

- First, since Dr. Joya is an experienced Bypass doctor who is also the pioneer doctor for the Gastric Sleeve surgery, he does the exact same tests required for Gastric Bypass patients.  He does not cut costs and corners by not using a drain.  The first tests is a blue dye test.  Secondly there is a Flouro Xray that includes a swallow (this allows him to see your stomach and fluids flowing through it).  Don't be fooled by inexperienced doctors who do not use drains, these are usually lapband doctors who are trying to start out with a new surgery.  Leaks are important and a drain and blue dye test is critical.

3. Does Dr. Joya hand stitch the sleeve after using the staples?

- Any and every Gastric Sleeve surgeon hand stitches behind the triple line of surgical titanium staples.  There is only one staple gun that is used for the Gastric Bypass and Sleeve surgery and this is made by Johnson and Johnson.  This device is used by Dr. Joya, who then hand stitches the sleeve behind the staples to help prevent leaks.  ALL DOCTORS SHOULD STITCH BEHIND THE STAPLES.

4. Why do other doctors require a shorter stay?

- The main reason is money.  They want to make more money while risking your life.  Dr. Joya who pioneered the Gastric Sleeve surgery has implemented the ideal number of nights for recovery from the surgery prior to sending you home so that there is very little risk of having a complication once you get home.  This in turn will reduce any future costs you may have to spend to return.  Other doctors go with a shorter stay so they can either charge a lower price, or provide inferior care.

5. When did Dr. Joya start doing the Gastric Sleeve?

- The initial Gastric Sleeve surgery was done in Europe in 2006.  Dr. Joya started doing the Gastric Sleeve surgery that year.  There are doctors who claim to be doing surgery since 2004 (with 4 years of experience), these Doctors are lying to you and are providing false information.  These are most likely Lapband doctors who have only been doing surgeries for 4 years at most.

6. Why choose Dr. Joya

- If you want the doctor with the most experience with regards to the Gastric Sleeve, and a doctor who is a surgeon and gastroenterologist, a pioneer in his field and an instructor in the Gastric Sleeve surgery for other Mexican doctors, then these are all reasons to choose the very best Gastric Sleeve doctor in Mexico.

LAP-BAND SPECIFIC

1. How many people reach their goals?

- About 95% of Dr. Joya's patients reach their goal. Those who do not reach their goal normally lose a lot of weight, but just lose about 60-80% of their weight with the Lapband and 70-80% with the Bypass. You need to set your goal reasonably and diet. The band is a tool, and as such, you need to work with it, it is not a miracle pill.

2. How many people keep their weight off for ever and never gain it back.

- Most, actually you should never gain weight using the band, unless you start eating high calorie liquid food (milk shakes, ice cream, beer, etc.)

3. How many people have the band slip and the surgery is unsuccessful?

- Less than 1%

4. How many people have the band be to irritating to keep and have to have it removed.

- Less than 1%

5. How much does it cost if it does need to be removed.

- The cost is comparable to placing the band. If it can be done via an endoscopic procedure then the cost would be much less, but on average it will cost around $6000 if you have to go to the hospital.

6.Will I never be able to drink Pop again?

- Yes, some patients have trouble with Pop and carbonated products however others have no problem other than a little gas, side effect.

7. Which surgery is right for me.

- The depends on your eating habits. If you are a sweet eater, than maybe you are a Bypass Candidate, if you are a large quantity and non sweet eater than the band or Sleeve is perfect.

8. Why are people so hungry at first

- They are hungry usually because they have not eaten for a few days because of the diet related to the preparation for surgery. However, you should feel full after consuming small amounts of water or juice.