Another Step Forward: Primary Care Doctor Checklist

I saw a primary care doctor in our town today. We don't have a family doctor; they are in very short supply in rural and remote areas. I really dislike not having a family doc, but we can always see a doctor with very little waiting. There is one young female doctor who I've seen several times, who I like. I always request her, and so far that has not been a problem. It's not the same as having a family doctor, but it's better than seeing a different doctor every time, walk-in-clinic style.

So today I told Primary Care Doctor that I've decided to get the surgery done privately in Mexico, and I need a few things in order to move forward. PCD ordered the blood tests and an ECG. After that, we'll do a physical, and if everything is OK, she'll write a letter that I'm fit for surgery.

She asked about the services that the private clinic provide: is there follow-up, a dietitian, an endocrinologist? I told her that I have the booklet (more like a manual) from the bariatric clinics here in BC, and I am hoping that I can work with the dietitian here at the primary-care centre. In addition, I am good at doing my own research and following an eating and exercise plan. Those things are not new to me.

PCD encouraged me to tell the BC bariatric clinic that I'm having the surgery, and see if they will do follow-up with me. It seems like a good idea to do both.

I'm getting the blood work done on Monday, and should have everything in place next week! I'm happy and excited.

Right now, the thing that's bothering me the most is flying while covid-19 is still active. It's a risk, and I wish I didn't have to take it.

Concerns About the Surgery

I want to write about some of my fears and concerns about the surgery, but I feel the need for a preface. 

I am comfortable with my decision to have bariatric surgery. But the way I see the world, nothing is perfect. The best experiences have downsides, and usually even the worst experiences eventually bring some silver linings. Everything is a trade-off. If the downside is occasionally annoying or troublesome, that doesn't mean the decision is wrong or a mistake. And it doesn't mean we have to pretend the downside isn't there. 

I have certain fears and concerns about what my life will be like post-surgery. I'm not freaking out, I'm not losing sleep, and I'm not having second thoughts about my decision. But the concerns are there. I need to write about them, in order to think about them and process them.

* * * *

I have three major concerns about the surgery:

- the pre-surgery fasting,

- my enjoyment of eating, post-surgery -- and forever, and 

- having to weigh myself, and this possibly triggering unhealthy patterns.

Fasting before the operation may seem like a silly thing to be concerned with. You drink Optifast or something similar for nutrition, and you don't eat. This shrinks the liver and makes the surgery safer. Most patients do this for two weeks. Some morbidly obese people are told to do it for a full month.

I'm not good at fasting. I have hypoglycemia, and when I am hungry and my blood sugar drops, it is very unpleasant. I get headaches, cannot concentrate, feel irritable and shaky. Perhaps drinking the Optifast prevents the blood sugar from dropping. 

I know it is temporary and short-term, but I am nervous about it.

The post-surgery terrain is long -- it's forever! -- and it's much scarier. I love good food and I love to eat. I think eating good food is one of life's most basic pleasures. Will I still have this pleasure in my life, post-surgery, or will it be a thing of the past?

Perhaps my love of good food will become part of my past, and I won't miss it. I can think of many things that I really loved and enjoyed while I did them, but when my life changed, I didn't miss them. My partner and I used to love to go to high-end restaurants when we lived in New York City. We spent a lot of money going out for dinner, and I never regretted a penny of it. When we left NYC, we stopped doing this, and I never missed it. I still enjoy going to a great restaurant as a treat, but that's not a regular part of my life anymore, and that's totally fine.

I can think of several other (non-food) examples of this. Will my love of food fall into this category? Will that leave eating boring and colourless? 

Of course there are huge upsides to this piece. Many people say after the surgery, they have to remember to eat. I am almost always hungry. No longer having that in my life would be incredible.

Lastly, and most importantly, is my dread of having to weigh myself and track my weight. Many of the behaviours that people are supposed to adopt before and especially after bariatric surgery are exactly the behaviours that signal eating disorders. 

There are no quick fixes for this. It's going to take a lot of willpower, and mental energy, and maybe some therapy, to track my progress without becoming a slave to the scale. I've written about this before, and I'm sure I'll revisit the topic many times. 

Of course looking at the downsides on their own leads to a very negative conclusion. Presumably, along with these concerns, there will be a significant reduction in my weight, and improvements in my health, and those together will lead to many positive benefits.

Clinic Approvals, Timing

Endo Bariatrics, in Piedras Negras (near-ish San Antonio, Texas), approved me for surgery almost immediately. They are now bombarding me with marketing emails, especially from their patient coordinator, a former patient herself, who used to weigh 400 pounds. I don't want to unsubscribe until I'm approved at the other clinic.

Oasis of Hope, in Tijuana (near San Diego), has asked for additional information -- a blood panel, an EKG, and a letter from a primary care doctor clearing me for surgery. Unfortunately, like most people in our town, we don't have a family doctor, but there is a primary care doctor that I see more often, the same doctor who referred me for the surgery in BC. I have an upcoming appointment to see her, and presumably I'll be able to tick the boxes soon after that.

After that, I can schedule the surgery anytime in October or November. There will be the two-week fast before surgery, which I have concerns about. But the big takeaway: it's happening soon.

A Little About the Process

First of all, I've changed my mind about which clinic to use. The Oasis of Hope Bariatric Center has a lot of experience, an excellent reputation, and hundreds of former patients singing their praises online. The fee, converted to Canadian dollars, comes out to $5600, plus air fare. That's a big enough expense. I've decided that I don't need to double that, just to get the Number One guy. The Number Two surgeon will be fine.

I can have the surgery any time I want. The clinic will tell me what days are available, but it's basically as soon as I'm ready. I'll do a semi-fast liver cleanse for two to four weeks -- the clinic will tell me how long. Some bloodwork, an EKG, and I'll be ready to go.

Allan could come with me and stay in the same room, but we've decided that double the air fare, plus dog care, is prohibitive. Plus we don't have dog care right now, so it might mean leaving the dogs at the vet's kennel, and we're not keen on that. So I'm going alone. An adventure!

I'll fly from Port Hardy to Vancouver to San Diego. The clinic will pick me up at the airport. The facility is about 30 minutes away.

Day one, the day I arrive, hey'll do any final bloodwork, and I'll meet the surgeon and the anesthesiologist. 

Day two is the surgery. I'll spend the day recovering in a private room.

Day three is a full day of recovery. 

Day four, the clinic drives me back to the airport and I fly home.

Upon return, I'll have to self-isolate for two weeks, according to Canada's covid traveling restrictions. That's easy for me to do, because I can work from home.

Post-surgery there is a lot of adjustment. At first you can only have clear liquids. Then you advance to thick liquids -- blenderized food. Then you have to re-learn how to eat.

That will be a long process, and it may be a difficult one. If I were having the surgery done in BC by our public health care, there would be mandatory sessions with a registered dietitian who specializes in post-surgery care -- counseling, weigh-ins, and so forth. I'll have to arrange my own support, but I can still do that through public health.

For now, I'm focusing on the present.

I Found the Best (Bariatric) Surgeon in Mexico

I have been reading copious threads in forums, along with reviews on Google and Facebook. I know how to tell the difference between real reviews and stealth marketing, and I'm quite sure these are real reviews by real people.

I quickly narrowed it down to two clinics. One is immediately over the border from San Diego (California), and one just over the border near San Antonio (Texas). They both are clean, modern facilities with English-speaking staff, and top-notch surgeons. They pick you up at the airport, you stay at the hospital the whole time, and they drive you back to the airport.

The one near San Diego sounds very good. It has hundreds of 5-star reviews, a very low complication rate. They have several surgeons and offer a choice of several surgeries.

The one near Texas is the private clinic of (what seems to be) one of the most experienced bariatric surgeons anywhere. This doctor pioneered the gastric sleeve. That's all he does, and he's the only surgeon there.

I like that. Many places have several surgeons, and you don't know who you're getting until you're there. Or, you expect to see Dr. X, but you get there, you learn Dr. Y will be performing the operation. 

I also like that he offers only one surgery. It means he's got lots of experience.

I don't mean to harp on the relative costs of these, but this is where we are.
Montreal - $20,000 or more
near San Diego - $5,000
near San Antonio - $11,000

The $5,000 price tag is tempting, and it comes with my second-choice hospital. It has an excellent reputation. I'm sure I'd be fine there.

But since we're talking about surgery, it would be best if the final decision didn't come down to price. This is a stretch, but it's possible.

So, I'm going with Endo Bariatrics.  (The runner-up, if you're curious, was Oasis of Hope. They were first and still are a cancer clinic.)

Now that I've made the decision and have chosen a doctor, I'm really excited to get going. 

* * * *

I thought I announced this in a subsequent post, but now I can't find it. I ended up choosing Oasis of Hope. Endo was more difficult to get to, plus they approved me for surgery in less than five minutes. This made me a bit wary. 

Oasis of Hope is closer to home (easier to get to), has an excellent reputation, and didn't approve me for surgery until they had more medical information. And do I really need to spend an additional $2,500?

Real Answers to All My Questions: Forums

Last night I told my partner I was still unsure about whether or not to have the surgery done in Mexico. I need more independent information about clinics and doctors. That's what it's all about, right? The competence of the surgeon and the quality of the clinic.

As we were talking about it, I suddenly realized what I needed: a forum. Message boards. 

A quick search turned up many forums about bariatric surgery. Naturally people are posting and sharing about every aspect of the surgery, from the initial decision, questions about specific issues during the life change, and the inevitable progress reports. 

Every forum includes a board specifically on surgery in Mexico. There's a lot of discussion about which surgeon to choose, and reviews by people who went to this or that surgeon. 

This is exactly what I need to make an informed choice.