Robert Marema Bariatric Surgeon

My first impression of Dr. Marema was he was tall. I stilll think he is tall.

His office staff is terrific! They are the best group of people you could ever want to meet!

The thing I like least about Dr. Marema, . . . I really don't have an opinion on that.

If you are a patient of his, make sure you go to all the lectures, no matter what your family and friends say about it. They don't have to live with the results of the surgery, you do, so you should know what to expect.

Surgical competance will keep you alive, but without a bedside manner, the time in the hospital gets really bad. Fortunately, there is a whole ward of people at the hospital that are there for the same reason. And they are a great support group.

While I have been working with Dr. Marema's office for several months, I have yet to meet him. I guess I don't expect to see much of him as this is a huge practice which has a number of people providing services for patients. Anyway, I've been approved by my insurance company and am quite happy with the office as far as follow-up is concerned.

While I have yet to meet Dr. Marema, his program is worth writing about. What follows is from my journal, which can be read at www.tedlehmann.comPart V – Fort Lauderdale, again – October 25 – 26, 2001

Violet calls to tell me my surgery is scheduled for January 9, 2002 with Dr. Marema. After all I’ve heard, I feel lucky to get the master himself. Every time I hear people talk about Marema or read about encounters with him, he emerges as caring, highly skilled, tough minded, demanding, and effective. People seem to dread his directness when they don’t follow the program, yet they’re grateful to be told what they don’t really want to hear, but know is the truth. I’ll meet him for the first time on November 20th for a pre-surgical consult. That will probably be the first and last time before they transfer me to the table. I know he’s busy operating and administering a large and well-oiled operation, so I don’t expect him to hold my hand. He’s put together a strong support system with fine staff to meet the personal needs of patients.

On Thursday we drive across Alligator Alley again and into Ft. Lauderdale. Part of this trip includes scouting out the sites of the hospital, doctor’s offices, resource center, and finding a place to stay. We check into the Fairfield Inn, a Marriott Motor Inn, which is less than a mile from Holy Cross Hospital where Dr. Marema will perform the surgery. Then we find a hospital parking block within two blocks of the doctor’s office on the grounds of the hospital, and enough out-of-the-way to have room for the truck - very convenient. I trudge down to the cardiologist’s office, as always, trying to catch up to Irene.

Dr. Font’s nurse, a short, blonde, rather rotund woman, briskly leads me to an examining room. Matter of factly, she takes my vital signs and asks me why I’m there, then when my surgery is scheduled.

“January ninth,” I say.

“That’s too far away. None of the tests are good that long.”

“I had this discussion with your office last week. Dr. Marema’s office said I should go ahead and have the work done.”

“Oh…well…they would,” she rejoins with a dismissive wave of her hand and a shrug. I was put off by her attitude. Could she have meant that Dr. Marema’s office is such a factory that there’s little wonder they’re willing to have a test that would be outdated by the time surgery rolls around? Or was her hostility more deeply rooted? Could she have just been hostile to a person who’s taking charge of his life and doing something about his obesity? She was pretty rotund. Is it possible that obese people are more opposed to bariatric surgery than others might be? Or could it be that she was tired near the end of a long and frustrating day. She put me on the table, attached electrodes, and ran an EKG.

The cardiologist, Dr. Font, comes in to complete the examination. A small, friendly man, he listens to my chest, asks some questions, and starts writing orders. Chest x-ray, nuclear stress test, echocardiogram I need to have them all. Luckily they can squeeze them in this afternoon and tomorrow. I won’t have to come back for another visit. We trot down the outdoor hallway to another office where I am quickly ushered into an area filled with a maze computers, and machines for nuclear imaging and echocardiograms. I am told that today we will do the exercise component of the stress test and the echocardiogram, while tomorrow we’ll do the resting stress test.

A nurse inserts an IV needle in my arm while another shaves my chest and attaches a series of electrodes. I lie down on a bed and Dr. Font comes into the room. Dr. Font comes into the room and a nurse pushes some fluid into the IV needle. All Hell breaks loose. My heart races, my chest tightens up, a flush comes into my face. I feel like I’ve been running for fifteen minutes. The entire stress test is chemically induced. I don’t have to move a muscle to have a great workout. I ask Dr. Font why it’s necessary to have a physician present for the administration of this test since he hasn’t said anything to me about the risk factors. He says that one in a thousand people have a heart attack during the test while one in ten thousand die. Oops! Six minutes later, the nurse turns on a sonogram machine, pops a tape in a recorder, and starts taking pictures and recording sounds of my heart. The echocardiogram is interesting and necessary because I had taken a course of Phen/Fen a few years earlier. Pretty easy stuff. As soon as the echo is done, they take me into a room where a table runs lengthwise through a couple of large, round circles. I lie on the table and the camera moves over my heart. I lie with my arms extended over my head while the camera grinds and groans for ten or fifteen minutes taking pictures of my heart. No wonder my blood pressure is high today! Everyone in nuclear medicine has been thoughtful, light, and humorous. They’ve made what could be a difficult and stressful afternoon of tests pretty easy.

I am eager (anxious) to find Dr. Marema’s office, get the lay of the land, and meet some of the people I’ve dealt with for months now. As is so often the case, Marema’s office is in a building on the edge of Holy Cross Hospital’s grounds. All three doctor’s offices are within a few hundred yards of the hospital but set on three different sides. We take the elevator to the third floor and walk into a large, irregularly shaped room filled with fat people. The walls are decorated with stone and huge round settees without arms fill the room. No one in Marema’s office needs to worry about not fitting in the seats. I ask for Joanna Hathaway, the nurse who was one of the leaders at the support group we had attended the previous Saturday. She can’t come out, but her assistant, Dee, arrives and sits with us for a couple of minutes. Almost as soon as we meet she says, “I had the surgery two years ago, and I’ve lost 125 pounds. I’ll never regret having it done. I’m sure you’ll be successful, too.”

I ask to meet Violet Ferris, the voice on the phone, just to make faces, names, and voices fit together. In a few minutes the top of a Dutch door swings open and a trim woman sticks her head out. She smiles and tells me, “I had the surgery five years ago, and it changed my life. I know you’ll be successful.” Almost all the staff in Dr. Marema’s office have had bariatric surgery. He himself had it, his wife and family. They constitute a remarkable support group as well as a well-oiled machine.

At six o’clock we arrive at the “Food for Thought Resource Center” for the Life Strategies meeting. The Center for Obesity Surgery charges a $600.00 program fee above the costs of medical care. This fee pays for the variety of support group and educational programs they sponsor. Having attended two different kinds of meetings so far, it seems to me the money is well spent. If $600.00 buys the effective office staff and caring support for people who have often been made to feel they don’t matter, then it’s a great investment in successful surgery and weight management.

The Life Strategies meeting is conducted by Joanna Hathaway, a nurse educator who has herself lost over three hundred pounds. Using Dr. Phil McGraw’s book as a source, the meeting began with a rather tedious round robin reading of a chapter from his book. While the suggestions and personality characterizations were apt, we didn’t stop to do the exercises he suggested or do the work necessary to make the connections to ourselves. During the reading there is little comment. However, once the reading end, the meeting turns into a lively discussion featuring support for a troubled member and lots of shared information for us all. A pair of twin sisters who have each lost of 200 pounds talk about the similarities and differences in their experience. A woman only a few weeks post surgery agonizes about her situation, but leaves the meeting looking as if she feels much better. Irene asks some questions and several people stop to talk to her about ways to provide support. We return to our motel room tired, but I’ve learned a lot.

On Friday I have a visit to a Pulmonologist and the second half of my stress test scheduled. Hoping we can get under way a little early, we stop at the Pulmonologist’s office and are happily greeted and told they’ll fit us in early. A nurse has me breathe into a little computer three times, takes my vital signs, and says the Dr. will be right in. My blood pressure is thirty points lower than yesterday. Dr. Sorhage is a slender, pale, blonde man about the age of our oldest son. He asks me my age, and I tell him and then ask him his. He responds defensively so I say he looks about our son’s age and that wisdom and age are not necessarily related. A pretty defensive response, which my explanation about our son doesn’t help. He loosens up a bit when I ask him to explain the lung capacity printout from the little computer. He listens to my vital signs and hustles me out. I’m cleared as far as my lungs are concerned.

We go over to the cardiologist’s, drop off my x-ray, and walk to a nearby Thai restaurant. Wonderful food, beautifully served. We return and I’m called into the back where the nurse takes a hypodermic needle out of a lead container - more nuclear medicine. After allowing the drug to circulate, I’m put back in the camera for the resting portion of the stress test. The camera moves over me for fifteen minutes, and they send me home. The drive across Alligator Alley is boring and traffic at the Peace River Bridge has been stopped for five hours because of a deadly six-car pileup. We get home two hours late, but the trip has been useful and interesting.
November 20, 2001 – The Surgical Consult

I’ve gained ten pounds in the past two weeks. Since my friend Steve’s arrival we’ve been eating out more and I’ve allowed myself to stop swimming. A pre-Thanksgiving weekend in Pennsylvania has capped this off. My mother-in-law decides to treat us all by ordering a restaurant quality standing rib roast from a caterer. It arrives, a huge piece of meet, wonderfully pink on the inside with succulent fat and well-cooked regions on the outside. I stuff with this magnificent beef, which tastes better than any beef I’ve eaten in twenty-five years. I don’t walk or swim or ride, I just move from the chair to the table and back for two days. We spend two more days in airports and on crowded airplanes, arriving at Ft. Myers near midnight. I make all this worse by deciding to save time by not setting up my C-PAP machine. I lose two hours sleep trying to breathe before Irene wakes me to stop my snoring. As soon as I set up the machine I fall into a deep sleep.

We arrive in Fort Lauderdale just in time for the 10:15 appointment with Dr. Marema. I’m pleased that he’s doing the surgery since I understand it’s not always easy to get him. Shortly, we’re called back to begin. I expect to be taken to an examining room right away. However, this is to be a much more elaborate day than I had expected. The first stop on this odyssey is the measurement room. Used to small examining rooms, the spacious room we start in surprises me. It contains a scale such as I’ve never seen. The scale features a yard square platform almost flat on the ground, two handles for balance, and a digital readout. You could probably weigh an elephant on it. I step on and weigh in at 360 pounds, more than I’ve ever weighed and I feel a deep disappointment. The pleasant attendant then sits me in a wheel chair wide enough to accept the biggest butt imaginable. She takes my vitals. Then she measures my height on the most precise gauge I’ve ever seen, made of metal and measured off in tenths of an inch (maybe centimeters too) it is set on the ground rather than on the top of a scale. I am 5’ 11” tall, a little taller than I expect. Finally, she takes a couple of weigh-in digital pics. I’ve now given the BCOS (Broward Center for Obesity Surgery) a baseline against which to measure the success of my surgery.

Vicky picks us up in the hallway and moves us into a large examining room. She gives me hospital gown that actually fits, perhaps even hangs off me. I recognize Vicky immediately from her picture on the BCOS website. She’s had bariatric surgery herself and has gone from looking like something of a blimp to being a pixie. Several people in Dr. Marema’s practice have had the surgery, adding to the sense of commitment and understanding permeating the offices. I don’t see Vicky again, but I’ve been glad to interact with her, if only for a few seconds.

There’s a knock on the door and in comes a nurse names Theresa to take my history and ask questions. I give her my photocopied list of drugs and she takes down the information. She goes out. Maybe the doc will be next. There’s a knock on the door and in comes a tall, lithe woman named Francine who introduces herself as the exercise physiologist. Francine gives me a printout with some exercises on it, demonstrates a couple and tells me that I’ll need to walk at least an hour a day post-operatively. She also says that any exercise I get during the next six weeks will contribute to making my surgery easier. I’m beginning to wish I hadn’t scheduled the surgery for immediately after the holidays as maintaining an exercise and diet regimen will be particularly difficult during this period. Irene sees ways she can help me with the exercises. I, of course, resist. Francine goes out.

The door starts to open and a hand reaches through. There are voices in the hallway, and the door closes a little, then opens again. A tall, thin distinguished man in a lab coat strides energetically through the door. I’ve been a patient in this practice for three months and this is the first time I’ve laid eyes on Dr. Robert T. Marema, the surgeon. He walks over to Irene, bends over, and sticks out his hand.

“You must be Ted,” he says with a big smile.

He walks over to me. “And you must be Irene.”

Having established a relationship, Marema shows why he’s so successful. As he looks at my records and examines me, he chats away, always talking and watching. He asks to see my gall bladder scar and tells me to forget laproscopic surgery. Irene comments maybe he can improve my scar. We talk briefly about Rving. His magnetism radiates through the room. Others have commented on this at the Association for Morbid Obesity web site, but since I think of myself as relatively immune to pizzazz, I’m somewhat surprised how taken I am with this man. I like him immediately and trust myself under his knife. I had had no expectations for a long or deeply thoughtful interchange here and I wasn’t disappointed. He palpates my abdomen and tells me I’ve been celebrating too much. He suggests I start on the Atkins diet for six weeks and loose a little weight. The Holidays loom before me. Within about ten minutes he breezes out and I get dressed again.

We are ushered out to some seats in the back corridor of this rabbit warren suite of offices. We go from the insurance office where our real vitals are checked to an office where they make certain we have jumped through all the right hoops. Of course we had missed the “nursing education” session so the three-hour meeting is scheduled for two days before the surgery. I had thought I was excused from this meeting, but no luck. We sit back down only to be ushered into Mike’s office. Mike turns out to be a pastoral counselor who tells us he’s available for prayer and spiritual support as long as we’re associated with BCOS. I tell him I always appreciate a prayer and will look forward to seeing him while I’m in the hospital. Gently, he raises the issue of a living will. While we both think we have one, I fill out the form to allow the docs to let me go if necessary. Pastor Mike reassures me that Holy Cross Hospital is willing to follow these dictates. While the hospital is Roman Catholic, he’s a Baptist preacher and perfectly comfortable being associated with Holy Cross. He’s now the full-time pastoral counselor for BCOS.

During our discussion it emerges that BCOS is in the process of becoming the American Centers for Bariatric Surgery. I tell him how impressed I have been with the process of the Center. He says that it has become internationally well known and is now functioning as a model for other centers. They’ve decided to take the model national. He’s vague about the details, saying only that they don’t exactly plan on becoming franchises, but…. While presenting a face of helpful caring, BCOS is also a very well organized machine for generating lots of money for four surgeons working very hard. The process seems almost seamless, allowing us get support, education, and encouragement from a very well trained and highly motivated staff without taking too much time away from the surgeons doing what only they can do – cut. Irene expresses a sense of slickness, for me it’s more like solid professionalism, but the process sure makes you feel like things will work out and the people here care. Nevertheless, Dr. Marema’s patients express great affection for and trust in him.

Next we’re taken to Dr. Parrish’s office. Parrish is a slight, gentle man with a white beard. He looks like what he is – a shrink. He ushers us into a comfortable office. The furniture is again oversized. No one need feel uncomfortable here. He asks about my feelings about the upcoming surgery. I tell him I lied to Dian Propis about my reactions to stressful situations. He said, “It’s called denial and everyone does it.” He talked about some eating behaviors, which would make it possible to stretch three ounces of food into twenty minutes of eating. Beats me. After about twenty minutes in the shrink’s office we were trundled back into the hall and were done. What I had expected to be a twenty-minute exam and consultation had taken over three hours and we had more on our plate.

After spending a couple of hours finding a room for the time of the surgery and grabbing a quick lunch, we returned for the “nutrition education” session. Abbe Breiter is a young blonde woman who has a self-assured manner and a New York attitude. Very refreshing. Her Power Point presentation covers lots of ground about the hospital stay, the period immediately after the surgery, food choices, food preparation, the chemistry of the program, labeling, maintenance, food supplements, and other important nutritional elements. People ask lots of questions, which Abbe handles with wit and what seems to be a complete absence of defensiveness. She shows some concern when people indicate they have been hearing different material from her than they had from other people. She is realistic in her assessment of how much people can retain, saying that there will be another meeting in six months for transitioning.

It has been a full day. We’ve seen the Broward Center at its organizational best. It seems to function like a well-oiled machine, inducting and educating patients, bringing them on board and preparing them for life-altering surgery. We head home, skipping an evening meeting, confident that we’re ready for the next steps to come. We won’t return to Fort Lauderdale until January.

He is a very caring DR - I would recomend him to everyone in need of this type of surgeon.
None at all he is great.

They are all careing just like him.

Everything was great.

He has gone through this surgery also.

It is very important.

Aftercare is also important.

Everything was explained in great lengths.

He is the greatest - best doctor that I have had.
Both

GREAT

EVEN BETTER

WONDERFUL

NOTHING


ALOT THEY WILL MAKE YOU ATTEND SEMINARS BEFORE SURGERY SO YOU FULLY UNDERSTAND WHAT YOU ARE DOING

YES A TOTAL SUPPORT GROUP NUTRITIONIST ,SHYCOLOGISTS, EVERYTHING

EACTLY HOW THEY ARE NOTHING LEFT OUT

HE ALSO HAD THE SURGERY DONE ON HIMSELF AND MOST OF STAFF

Dr. Marema and his staff have an incredibly comprehensive program. Very personable people and highly professional. He and his staff rate a 10 out of 10. I would not have even considered this operation with another surgeon.

My first impression of Dr. Leonard Benitez was good. He was very informative, willing to answer all my questions and had a sense of humor. The office staff was wonderful, each and every worker there made sure you had a smooth transition going through all the steps with no confusion. I am very confident in him due to his vast experience in lap surgery. My family doctor sai Dr. Benitez could take anything out lap that is how good he is. It made me peace at mind knowing he had extensive experience in this field. Broward Obesity Surgery Center makes sure you know each and every step they take in order to have a safe flawless surgery. They give you plenty of classes to take to learn what will happen, what to expect and the outcome. He said with any sirgery there are risks. This is a major surgery and he stated what steps he takes to ensure no complications arise.

Dr. Marema was my surgeon...He was excellent as a bariatric patient himself I felt fully comfortable knowing that he had gone throught the same thing I had been through. All this man does is Bariatric surgery.Since I have had my surgery he has taken on 2 partners . My sister is having the surgery ow I was her guinnea pig. The office staff was wonderful, friendly and never acted like I was bothering them. They have a person there working specifically to fight the insurance companies for you. I cant really say there was anything I didnt like about Dr. Marema. There is a very structured program with Dr. Marema. It has gotten alot better since I was going throught he surgery. I have gone to several of the appts. with my sister and they have introduced ALOT of new programs. Lots of support too. I would give Dr. Marema a 110% aproval....He and his staffed changed my life. I believe surgical competance and bedside manner are both equally important.

he is very understanding of his patients needs.


his staff is extremely educated and caring.



He and his staff offer the best support sytem offered to patients


His aftercare program is remarkable.

he will answer all question with honesty.

he is the best doctor around.

My first impression of Dr. Marema was that he understood exactly what i was feeling. I knew he could help me.

My impression has only improved. He is very professional and his staff is great!

Dr. Marema's staff is wonderful. They all know me by name, which is awesome. And the greatest thing is alot of them have had the surgery so it's less frustrating to discuss things with them because they know.

Nothing bad to say.

He educates you fully on the type of procedure you are having, take advantage of this, it will help you understand what your body is going through.

Emphasizes aftercare alot!

yes

Very deeply. He discusses all risks and thensome very explicit.

Excellent! The best!

Both outstanding!

I was very impressed with Dr. Marema and the efficiency and kindness of his staff. They are extremely organized and have great support services. I have had no negative experiences so far. I will let you know after the surgery how it all holds up.