BMI 55 and over

I think all of us on this board support Ontario, and the willingness to resolve the obesity issue.  What I don't support is many of the "new" evaluation / surgery centres are novice and jumping into to water that they can't swim in.  They are barely treading water.  What should have happened, is a slow process to move from the US surgery programs to Ontario programs.  Why they felt a need to change everything all at once instead of gradually is a very poor decision.  Because of this, we are dealing with longer wait times, more complications and sadly, more deaths. 

As for the comments about people losing weight...well some folks with a BMI over 55 cannot lose.  This is why they got to that size in the first place.  Not giving them a surgery that could save thier lives when they need it is sickening.

The approach in Ontario appears to me more multi-disciplinary - so that will take longer, but hopefully it will result in better long term outcomes. By following a systematic approach- education, diet evaluation, psych eval, internal med eval- EKG, sleep studies, upper GI etc, the patient has a full assesement done and as many risks have been reduced as possible.
I don't know what happened before this- but I have not had a sleep study, nor blood work. I will be having pre-op blood work etc. It's probably ok for me, with a lower BMI, but what about someone with a higher bmi who has undiagnosed sleep apnea? They will have a harder time losing weight.

If the out of country people just met the surgeon and WHAM had surgery - yes that is faster. But is it better? This way more people can have surgery, not just the few who knew about out of country and were able to get their doctor to sign a form.

I think if someone can't lose on optifast or similar - there is a problem and either the person needs altered medication or a re-evaluation of their desire to lose weight. I know I can lose weight- it's keeping it off that's a problem.

I don't really have much umph to argue your points....I'm not sure I could change your mind or that I really care too....

I agree that having surgery in province is more desirable...however, having people who have JUST learned how to do a surgery is not who I want...especially given that my BMI was very high so the risks are greater.  I started out at 426 lbs.  To get under a 55 BMI I would have had to have lost 85lbs....that would take months on optifast, let alone without optifast...is it doable?  Maybe, desirable - definately not.

Regarding your comment about pre-op testing....there isn't a surgeon in the world (or one that OHIP would have approved anyway) that would just give you surgery without pre-op testing....at the very least it was required to have blood work.  If the surgeon suspected you have sleep apnea then a sleep study was a must - and being on CPAP for a period prior to surgery was necessary too.  A surgeon from the US is way more experienced than most of the surgeons we now have in Ontario - they wouldn't opt to operate on someone who they didn't think was a candidate, they have their reputation to protect.

In addition to all of this - one surgery which is the most successful statistically isn't even performed by any of the surgeons in Ontario.  By limiting people to having surgery within Ontario you are limiting their options and therefore their likelihood for success.  Is having surgery within Ontario desirable yes - but it's not the be all and end all.  Even without the wait times for getting surgery, it's still not the optimum since the surgeons aren't as experienced and they aren't even offering best option (again statistically speaking).

You didn't mention what pre-op testing was done at the US site where you had surgery. That might make me feel better about the US surgeries.  The minimum for ANY surgery- tonsils, appendix etc- is blood work, urine, chest-x-ray and if over 40- EKG. Any less than that violates the Ontario Hospital Act. If you were over 400 lbs, I would suggest that more complex heart tests- echocardiogram, stress test at a mininium. What about dietary counselling, pscych eval?  Sleep test, Upper GI?

As for band surgery- I expect that is the mighty $$$ speaking- it's a cash operation here, and as long as the basic stuff is done, there is no drive to be comprehensive in evaluation.

As for just learning to do the operation- I understand most of the surgeons in Ontario are FRCS- and have been mentored by more experienced bariatric surgeons. I also understand that at least one highly experienced bariatric surgeon was recruited from the US, and the McMaster University is recruiting an academic in Bariatric surgery. So there are plans to expand and meet the needs.

In the US there are surgeons who have not done a fellowship, nor extensive mentoring in laproscopic or bariatric surgeries. Not saying that the Bariatric surgeons *****ceived OHIP $$ were not skilled, but there are people going to the US, Mexico etc, paying up front- looking for a good deal - there are ads here on OH, members of OH touting for surgeons. It's scary.
I know Klien and Hagan are top laproscopic surgeons doing other surgeries- my doc tells me that they do the most bowel cancer ops in the province.

As for the DS- which is not done here, I'm not going to argue that it's right or wrong. Beating a dead horse will not make it walk again. I am surprised when people suggest I should look into getting the DS. I don't fit the criteria for it and reading the long term complications makes me shudder. If you want it or have it- fine. Just don't pu**** in every thread, it's getting a little boring.

None of my pre-op testing was done in the US - OHIP wouldn't cover it.  So MY pre-op testing was done here.  I did have the blood work, EKG, urine and chest X Ray. I was also required to have a sleep study because I had symptoms of sleep apnea.  No further testing was ordered - because I had no further symptoms of anything else.  I doubt if I had surgery in Ontario that I would have had any other testing either because again there were no symptoms of anything else so the testing wasn't necessary.

I'm not arguing that having surgery within Ontario is the best thing for Ontarians....I think it is.  The problem is they didn't start to improve Ontario's system until they stopped sending most people OOC.  It's like one day they recruited people to do surgeries within Ontario and the next they stopped sending people OOC.  They have a few extra surgeons but not nearly enough to do 1800 surgeries per year (I think that's how many were done last year in the US on Ontarians).  

As for people going OOC looking for the best deal etc....these people wouldn't be looking at the cheapest option etc if they could get the surgery they wanted within Ontario quickly enough -  as in you get referred and you start the process (classes, dietitians, testing etc) immediately.  I don't think anyone disagrees that classes, dietitian appointment, psych clearance etc  isn't a good idea.  While I didn't get all of that - and I really wish I would have had access to it! - I certainly think all of these things will get rid of the people who shouldn't have the surgery, educate people on what's expected and also make people feel supported.  I think a multi disciplinary approach is great - I've experienced this approach in my daughter's care (she had a cleft palate) and it's amazing.  I'd love it if I could call an office and get what I needed immediately.  Unfortunately, it's not what I was able to get....but that's ok cause I chose to go OOC to get the surgery I wanted in the amount of time that I was willing to wait.

And, finally, regarding your comments re the DS....ugh....you know what - because OHIP won't approve the DS is anyone with a BMI of less than 60, the DS is rarely mentioned anywhere on the Ontario board anymore.  So if you're sick of it then whatever....if everyone can talk about their surgeries then I can talk about mine and how great it is.  Most of us DS'ers rarely post anymore because we don't feel like we have much to add to a conversation since all that's usually talked about is related to the RNY or VSG. 

And you're wrong about not fitting the criteria for the DS.  You can get the DS if you qualify for WLS....it's only in Ontario that you can't (that is to say you can but you have to pay out of pocket for it).  Regarding the long term complications - studies (as in peer reviewed real studies) have shown they are no more prevalent and no worse than the RNY.  So the stuff you've read is likely the lies spewed by docs who want your business.  So my question is - if you fit the criteria, the long term complications are no worse than the RNY but statistically the outcome is likely going to be better - why would you choose anything else? 

PS...I'm being the devil's advocate here everyone - please don't jump on me - I get the DS isn't for everyone!

Ya, because we push the DS so much around here.  **** get a grip.   

We can "pu**** in every thread" if we want.  Are you the thread police?

I don't usually respond to these kind of statements, but wow, you come across as a real arrogant know-it-all.

Vent over.

On March 28, 2010 at 5:49 AM Pacific Time, supergirl3 wrote: We can "pu**** in every thread" if we want.  Are you the thread police?

I don't usually respond to these kind of statements, but wow, you come across as a real arrogant know-it-all.

Vent over.

ya know Erin, just out ot respect, I really try to make an effort not to boast about my surgery here on this board.  I mean, it's awful bragging about something that others do not have access too.  Although I have put on some weight from stuffing my face,  I am still within a "normal" BMI.    Oh and these awful "side effects" that she talks about, well, I don't have any of them and I had my surgery with starting BMI of 40, over three years ago. 

I'm so tempted to rally the DS troops on this thread just to remind her how quiet we actually really are around here most of the time.  I guess some would like us gone completely.

I agree Kel.  All those horrible side effects - like being able to run a 5k, shop for tiny, fabulous clothing, being able to eat what I want while maintaining a normal BMI - I wouldn't get the DS either.  OHIP must be right in not offering the DS, especially to those who do not "qualify" as she says. 

There hasn't even been mention of the DS in "every thread" like she says, because there aren't many new DSers unless they're self-pays.  Get a grip Louise, your DS-envy is showing.

LOL @ DS envy.  Careful, she might post some links about awful DS side effects LMAO