Spending the day with Dr. Gabriel Ramos, Oncology Surgeon

Spent the day in the operating rooms with one of my favorite Mexican surgeons, Dr. Gabriel Ramos Orozco.  Dr. Ramos is an oncology surgeon with offices in Mexicali (Baja California) and his hometown of San Luis Rio del Colorado in Sonora, Mexico.

Dr. Gabriel Ramos Orozco, Oncology Surgeon

Dr. Gabriel Ramos Orozco, Oncology Surgeon

In the operating room with Dr. Gabriel Ramos

We spent the day in his hometown – first at the Hospital Santa Margarita, where he performed a laparoscopic cholecystectomy, and then in his offices seeing patients.

In the operating room

In the operating room – photos edited to preserve patient privacy

Hospital Santa Marta

The hospital itself was a small intimate clinic.  The operating rooms were small but well-equipped.  We were joined by Dr. Campa, an excellent anesthesiologist and another general surgeon.  While the anesthesia equipment was dated, all of the equipment was functional.  At one point, the sensors for cardiac monitoring and oxymetry readings malfunctioned but within seconds a backup monitor was attached.  (This is a frequent occurrence in most hospitals around the world and the USA because the sensors that connect to the patient with gel are cheap disposable and somewhat fragile.)

There were several monitors dedicated to laparoscopy with good display quality.  The operating rooms had ample light and functioned well. Overall the clinic was very clean.

ramos surgery

The surgery itself proceeded in classic fashion.  The patient was positioned appropriately and safely before being prepped and draped in sterile fashion.  Since the surgery itself was of short duration, anti-embolic / DVT prophylaxis was not required but was still applied.  (Note:  in Mexico, these stockings are of limited utility – and for more lengthy procedures, TEDS or electronic squeezing devices are usually applied.)

The surgery itself was under an hour, with no bleeding or other complications. The patient was then transferred to the post-operative care area for monitored recovery from general anesthesia.

Dr. Ramos performs laparoscopic surgery

Dr. Ramos performs laparoscopic surgery

In the clinic

It was an interesting day – because he sees a diverse mix of patients.  As a general surgeon, he also operates for many of the classic indications, so there were several patients who saw Dr. Ramos for post-operative visits after appendectomies, cholecystomies (gallbladder removal) and the like.  There was also a mix of patients with more serious conditions like colon, testicular and breast cancers.  His patients were a cross section of people, from the United States and Mexico alike.

International patients

Some of these patients came for the lower cost of treatment here in Mexico, but others came due to the dearth of specialty physicians like oncology surgeons in places like Yuma and Las Vegas.  Many of these international patients spoke Spanish, or brought translators with them since Dr. Ramos is primarily Spanish speaking.

Since D. Ramos is not well-known outside of Mexico, many of these patients were referred by word-of-mouth, by former patients, friends and family.

Then it was back to the hospital twice to visit his patient post-operative.  She was resting comfortably and doing well.  It is this level of service that draws patients to his clinic both here and in central Mexicali.

This winter, Dr. Ramos returns to school so to speak – as he will be spending several months in Barcelona, Spain and Colombia learning new techniques such as uni-port laparoscopy.  He will then be able to offer these state-of-the-art treatments to his patients back here at home; whether these patients come from northern Mexico or other parts of the globe.

Highly Recommended:  Excellent surgeon with well-coordinated team.  However, patients requiring more extensive surgery (large tumor surgeries/ cytoreductive surgery) should request Dr. Ramos perform surgery in the larger Mexicali facilities for better access to advanced and specialized support services like hemodialysis etc. for sicker/ higher risk patients. 

However, the level of care was appropriate at this facility for this procedure, which is rated as low-risk.  (i.e. generally healthy patient, with straight-forward procedure)


In the operating room with Dr. Rafael Beltran, Thoracic Surgeon

Dr. Rafael Beltran, Thoracic Surgeon

Spent the morning at the National Cancer Institute, which really is a pretty amazing place, with a pretty amazing guy – Dr. Rafael Beltran. He’s one of the many incredible people I’ve met here – that truly make the world a better place through their work. I could have spent all day with him, seeing patients, surgery, discussing his cases and research – (Heck – I’d love to work with him!) but unfortunately, I had to race across town after several hours for another interview..

Dr. Beltran (tall gentleman on the left) and his surgical team

I really like this picture here, I think it highlights one of the important aspects of surgery – the surgical team.. As you can see above, Dr. Beltran (left) certainly doesn’t work in isolation – and that’s his philosophy about cancer care – the surgeons from different specialties work together closely, along with oncologists, radiologists, hematologists, therapists and other specialties to give well-coordinated, and well-rounded care. While I was the operating room, I stood next to a shy young woman.. After I badgered her for a little bit – she told me her story. She’s a respiratory therapist – and she was watching the surgery, so she would better understand how to take care of her lung surgery patients – and to understand exactly what they had been through. Not often do surgeons find room in their ORs for respiratory therapists – but Dr. Beltran understands that by having this young woman here observing – she learned more today than she could ever glean from books.. By doing so – he’s integrated her into the surgical team, and that’s important when often today’s medicine is an exercise in fractured and fragmented care.

In the operating rooms all around us – the same thing was occurring, with orthopedics, plastic surgery, neurosurgery.. As you can tell – on all my visits to the National Cancer Center, I’ve been very impressed with the physician commitment and the level of care.

As I raced off – I received a text that the doctor I was next scheduled to meet had to go to another hospital – he offered to meet me there, but he had an emergency, so I thought it best to reschedule for when he had more time.  I’m really looking forward to talking to him – so I didn’t want him to be too distracted.. I get the best interviews when we can just sit down and talk..

Then – a thoracic surgeon we’ve talked about before – texted me that he had 2 interesting cases – did I want to go? So I spent he remainder of the afternoon talking with Dr. Juan Carlos Garzon, thoracic surgeon. I’m glad I did – because I had lots of questions from our previous interviews, and between cases, he spent the time to answer my lingering questions; about his practice, about thoracic surgery in general, and about Colombian medicine so it was definitely a worthwhile trip..

  Dr. Juan Carlos Garzon, Thoracic Surgeon..

Thoracic Surgery portal

Over at our sister site – we’ve published the first few discussions on lung surgery, and lung diseases as part of our new lung surgery portal.

It is the first tentative steps towards a fully integrated lung surgery site – CirugiadeTorax.org
which I hope to one build into a one stop site for patients looking for information, the latest treatment and facilities for lung surgery, and lung cancer. I envision a site eventually filled with articles, links to treatment options/ and facilities along with physician profiles from different surgeons around the world, so patients have access to the newest, and most effective treatments possible.

It’s a big task to take on – but it all starts somewhere, and who better than I, a practicing acute care nurse practitioner, in cardiothoracic surgery?
I am already travelling, meeting thoracic surgeons, learning about new and different treatments at every opportunity..

Just posted new articles on Malignant effusions and Preventing post-operative atrial fibrillation..