A List of Good Things that Have Happened Since my Surgery

For the first time since making the decision to have bariatric surgery, I'm struggling. That in itself is pretty good. I decided in September 2019, so it's been nearly a year and a half with no significant issues. 

I can't and won't deny the issues I'm having right now, but a comment from my friend and blog reader "mkk" made me stop and take stock.

Up to now, any negatives I've experienced were physical, such as pain from eating too quickly, or nausea from eating too much, or the dreaded constipation. I expected things like this and -- although yucky while they are happening -- they're not a big deal.

The negatives I'm experiencing now are mental and emotional, and we all know those kinds of issues can be much more difficult and persistent. There are two issues.

• I am obsessing. Obsessing on calories, portions, weight.
• My appetite has hugely increased. This is very concerning to me, because if this whole process becomes an issue of willpower... it will not be sustainable. More about this in a future post. I'm not ready to talk about it yet.

Here are the positives that have taken place so far.

• I was terrified of the pre-op fasting, and it turned out to be fine. 
  
• I traveled to the surgery and back -- multiple flights and hotel stays -- with zero problems.
• My experience at the hospital in Mexico was excellent. 
• I traveled to the US and Mexico and back and did not get covid!
  
• Throughout my recovery, I was on paid work time, and working from home, so it was easy to work with the post-op eating plan and other self-care.
• A month before the surgery, I received a check in the mail -- out of the blue, totally unexpected -- that covered the full costs of the surgery! We ended up paying only for transportation, which was very manageable.
  
• My physical discomfort while recuperating was minimal.
  
• I've lost 39 pounds. This includes a sneak-peak at the scale in mid January. Without this surgery, losing almost 40 pounds was completely impossible.
• I'm comfortably wearing t-shirts that haven't fit me in 10 years.
  
• My low-back pain has returned to levels I experienced in the early 90s -- easily dealt with with a few stretches.
• My knees feel much better.
• An issue I was having with my bladder has disappeared. 
• My ankles and feet are no longer swollen -- a condition that was chronic.
• I am less self-conscious about my appearance in video-conference meetings (Zoom, Teams, Hangouts). This feels really nice.
  
• I'm still enjoying food! I was afraid that the surgery would rob me of this basic enjoyment, and that has not happened. This is wonderful.
• I'm still enjoying cooking, and my partner and I are eating mostly the same food.
  
• I'm able to eat almost anything in small quantities. I'm choosing not to eat unhealthy food, but if I wanted to have a small portion of something on my "avoid" list, I could. Having choices rather than being told what I can and cannot eat is important to me and much more sustainable.
  
• With my knees and back feeling better, I am already more physically active, and I'm feeling the rewards of that every day.
  
• And this is all without knowing the results of any bloodwork. I have my first post-op tests in early February.  

 Really great. 

The two issues I mentioned above are real, and they are troubling me. But they are not the whole story.

Two Days Post Surgery: On My Way Home

This morning I had my last round of intravenous meds and a nurse removed the IV. The patient coordinator went over everything, and gave me a care package of instructions, medications, and supplies to clean the wound where the drain was. They also gave me copies of the bloodwork results, EKG, and all the medical info so it can go in my records back home.

I'm feeling OK and eager enjoy a week of rest and relaxation. 

A note about this blog. As I've mentioned, I'm writing this for myself and perhaps for anyone who might need this information from a firsthand source. Friends and family are very welcome to continue reading, but please feel no obligation, and not the slightest need to apologize if you want to stop reading. Deal?

A Big Improvement in a Short Period of Time

It's still the first day after the surgery, and I feel better and better as the day progresses. The doctor removed the drain -- ouch!! -- and soon the IV will come out and I can take a shower.

The hives are acting up, so they're letting me take my antihistamines now. 

This morning I thought, how am I going to travel on Thursday? But I already see that it's possible, and won't be so bad. I have to be super careful not to lift my suitcase, and to ask other people to lift it for me. And I have to walk slowly. If I do those two things, I'll be fine.

I wish I could go all the way home on Thursday! But alas, I can only get as far as Vancouver, then will fly to Port Hardy the following morning. Then I have an entire glorious week off work. Can't wait.

 

Greetings from Oasis of Hope Hospital

I'm here! Today, the day I was most dreading, was fine. It was even fun! I love to travel, and I love to travel alone, and it doesn't really matter where I'm going. Or, apparently, how little I eat! I've been so travel-starved from covid that just having a change of scenery and flying places was a treat.

The two-week semi-fast clearly changed my appetite. At one point today I ate a 100-gram Greek yogurt and drank a tiny box of juice, and I was almost uncomfortably full, wishing I had saved the juice for later in the day! That is crazy! 

This surgery will really change my eating habits around travel. Travel, for me, is almost always associated with unhealthy eating choices, and often overeating. I guess those days are over. It was fun while it lasted! (Readers who don't know me, that was said while smiling and laughing.)

 

Everything went smoothly today. Masks are mandatory and there was plenty of room for social distancing -- until the flight to San Diego. It was packed. I wasn't too comfortable with that. 

 

The driver picked me up in San Diego as planned, and we were very quickly at the hospital. I had a long wait until finally someone appeared with forms and took me to my room. There seems to be a lot of administrative confusion, I think because I arrived at night, when there are fewer people on duty. 

But everything got done eventually. I'm in my room, they've taken my vitals, I've filled out forms, and signed scary disclaimers. I am excited and nervous! Can't wait to be on the other side.

* * * *

You know you're a busybody when you ask more questions than the customs agent!

Where are you going?

Is it for work or family?

For how long?

Where are you staying?

Going shopping while you're there?

Did you take the hotel shuttle last night?

How much was the cab?

Where do you live?

Is the weather nice there?

 

This was the other person on the hotel's airport shuttle this morning!

Some of these are perfectly legitimate small-talk questions -- but some are inappropriate. And honestly, on an airport shuttle, do you really need to know anything about the other passengers? 

 

FYI, I did not answer truthfully.

Greetings from Vancouver

I made it through Day One of the almost-fast, and I'm doing fine. I say almost-fast because the diet came with an escape hatch: "If you are diabetic, hypoglycemic, or you feel dizzy or lightheaded, you may eat one of the following..." 

So yesterday, in the early part of the day I had a 4-ounce can of low-sodium vegetable juice, and when I arrived at the airport hotel, I had one hard-boiled egg. Other than that, I had only water or juice. I never thought I'd be able to do that!

Silver lining. The urticaria has a special torment: after I eat, there is massive stinging, burning, and itching over my entire body. The stinging is actually painful. It feels like being stung by an insect, dozens of times, all over. Fasting has removed this particular hell. I still have itching, and I'm taking the antihistamines, but getting rid of the post-eating torture is a relief.

Yesterday afternoon I flew from our little remote town to Vancouver. The flight is about an hour, and if it's not raining -- which happens occasionally -- you can see the snow-capped North Shore Mountains the whole time. Yesterday was beautifully clear. 

I caught a cab to the Coast Airport Hotel, and because I'm a Coast Rewards member, they offered me a free room upgrade. So I'm staying in "King Superior" room for the ridiculous rate of $65. Coast Hotels are not usually so budget-friendly! I guess they need to compete with the other airport hotels. Pro tip: don't stay in a Day's Inn when you can stay in a Coast for the same price.

It's a good thing I'm not relying on the hospital for nutritional support. The dietitian sent me the diet at the last minute (which caused quite a bit of stress, as I thought I needed to order Optifast... and that would take time where we live), then never checked in with me. Not one call or email. I thought that was pretty poor. Fortunately for me, I have the RD from our local primary-care health centre -- and she is amazing. We're actually speaking today while I'm between flights.

Today is the challenging day: fasting while traveling. But yesterday's experience has given me more confidence. Yesterday morning I was thinking, How am I ever going to do this?? and this morning I'm thinking, I am going to do this. 

I know at least four people are reading this and have been incredibly supportive. I am profoundly grateful.

The Final Countdown!

I've completed the two-week semi-fast. 

I found that after a few days, my appetite sharply decreased, which I know from past experience is from eliminating most carbohydrates, eating only a small amount of whole grains. (I have always found this to be true for me, but also found it challenging to sustain, and easily undone.)

I'm caffeine free. I miss coffee and I can't wait to drink it again. But I didn't get headaches or suffer any other ill effects.

Today begins the final 48-hour fast. I'm dreading it. But... I'm resigned.

I checked my flights, and they are not crowded at all. This was definitely a relief. In this case, the optimist sees the plane as half empty!

Later today I fly to Vancouver, where I'll stay in an airport hotel. I will miss one of my favourite little treats when I travel alone: room service dinner and a glass of red wine. Nope. Water and fruit juice are the only things on the menu.

I've gotten amazing, steadfast, and caring support from my friends who are reading this blog. Thank you all!

One Week to Go: What's on My Mind

The surgery is in one week from today! 

My current concern is the travel. 

In the final 48 hours before surgery, you're on a true fast -- liquids only. During this phase, there are no protein shakes, just water, juice, or clear broth. People with diabetes (no) or hypoglycemia (yes) can eat a small amount of protein, such as a hardboiled egg, if they feel dizzy or lightheaded. 

This scares me, and doing this while dealing with multiple flights and layovers, and everything that's involved with that, scares me more. I know I'll get through it. I'm just kind of dreading it.

In addition to fasting, the severe urticaria (hives) I've been struggling with is back in full force. It was 90% gone, and the fact of its reappearance is not a good sign. It likely means this condition is chronic and will come and go repeatedly. The antihistamines help, but at various (unpredictable) times during the day, my skin is on fire with itching, burning, and sharp stinging.

And of course, there's covid. I'll do my best to distance, and naturally I'll be wearing a mask and using hand sanitizer frequently. I can only hope the airports will not be crowded, and the flights not sold out. (The airlines now allow you to check what percentage of seats have been sold, and re-book at no extra charge -- but if you have a connecting flight and an event you are traveling to, that's not much help.)

Fasting, itching, and social distancing. I normally look forward to any travel, but this seems onerous. Maybe instead of counting the days, as I'm doing now with the semi-fast, I'll count the hours. I'm also telling myself that the anticipation is almost always worse than the event. 

(A reminder: I'm not freaking out. Just expressing my concerns.)

On the way back, I'll also be a liquids-only phase, but according to the dietitian, this will be much easier, as most people have very little appetite at that time. The surgery itself is laparoscopic -- that's why you can travel so soon after it -- but still, it is surgery, and I'll need to be careful.

Once I'm back, I'll have to self-isolate for 14 days, which will be very easy, as I'm working from home. I've taken two weeks off work for the surgery and recovery, but even after that I have no need to go anywhere while the quarantine period runs out.

Meanwhile, in the present, the semi-fast and caffeine step-down are going really well. It can be a bit challenging to open the fridge and see the food I've made for my partner... and pull out only the coconut water! But I'm doing it -- one glass of water, one protein shake at a time. 

All Systems Are Go: Surgery and Flights Are Booked

It is on!

My surgery will take place on Tuesday, October 27. I'm really excited. I'm nervous, of course, but at a manageable level. 

On Monday, October 12 (Thanksgiving!) I begin the two-week fast. I spoke to the RD about this, and she said for most people, this is the worst part. The post-surgery liquid diets are not as difficult, because by that time, the stomach is very small, and fills very quickly. The most difficult part of that phase is ensuring your protein intake. 

But the pre-surgery fasting will be challenging. I'll be drinking Optifast, a protein-shake meal replacement. I'm especially concerned about fasting while I'm traveling down to San Diego. By that time I'll be off the protein shakes and drinking only water. 

The fasting is done to shrink the liver, which makes it easier for the surgeon to visualize using the laparoscopy -- which makes the surgery safer. In other words: important.

Well, everyone who has this surgery manages to get through the fasting, so I will, too. One day at a time. I'll count the days... and probably write a bunch of complaining posts. You've been warned!

Several people reading this blog have been very supportive. I appreciate it more than I can express. It means everything to me. Many, many thanks.

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. 

Moving Towards a Decision

At first, my research on private bariatric clinics focused on Montreal. Healthcare in Quebec is more privatized than BC -- probably more than any other province. 

In BC, private clinics cannot offer services that are available through the public health system.* This is a good thing, and I don't want it to change -- but since the province has capped the number of bariatric surgeries, BC residents are left without other in-province options.

Quebec, the leader in privatization (not good) is also the leader in bariatric surgery (good). There are clinics with exceptional experience and results, for people who can afford it. Gastric sleeve surgery is $18,000; gastric bypass starts at $23,000. That's without airfare and other incidental costs. 

And I was actually considering this. Which shows you how badly I want this surgery. We are financially comfortable, but we don't have $20,000 sitting around.

Financing is available, and I started looking into and rationalizing the expense. I can rationalize anything, and I was well on my way to talking myself intothis.

Then I did more research, and started looking into Mexico.

I know: it sounds alarming. Many Canadians and Americans think of Mexico as a place where everyone lives in shacks and walks barefoot, like one giant slum. That's just bias. I'm not saying that there isn't poverty in Mexico, but there's poverty in the US and Canada, too.

There is no shortage of sensational newspaper stories about people who had botched procedures in Mexico. It's a perennial of American journalism, and make good episodes on "House". We have no idea how prevalent those stories are, or how many botched procedures are performed in the good old U S of A. 

When it comes to reporting on health care, the American media has very low credibility. Everything Americans see and read about health care in Canada and the UK is wrong. Lies. Why would this be any different? Especially since many Americans think anyone who speaks Spanish is poor, ignorant, and untrustworthy.

Thousands of Americans travel to Mexico for treatments every year, especially from Texas, Arizona, and California. There are shiny, clean, modern hospitals, frequented by Americans who have been denied coverage by their insurance companies or who have no coverage. 

People also travel to Mexico for alternative cancer treatments that are not legal in the US. A former co-worker of mine had Stage IV breast cancer, went to Mexico, and was put into remission without surgery. Yes, I know that is merely one anecdote and not a scientific study. But she went to this clinic because of a preponderance of these stories. And she's still alive, with her body intact. A treatment that is unproven may still be effective.

In any case, one of the largest cancer facilities in Mexico is also a hub for bariatric surgery. At about $5,000 including airfare, the price tag is a lot more palatable.

It's not easy to find independent assessments of the Mexican clinics. I did find one study that looked at complications and outcomes in Mexico, based on 500 surgeries performed at one hospital over a period of 4.5 years.

The study found that in the well-established, high-volume Mexican bariatric clinics, the outcomes and rates of complications were comparable to similar hospitals in the US. There was no statistical difference.

This article looks at the cost to Canadian health care from complications from medical tourism. It profiles four cases of people who had bariatric surgery abroad, then had complications, and what the implications were for their provincial health systems. It doesn't compare complication rates from surgeries between countries. 

In the conclusion, it states:

Our limited, anecdotal impressions are that obese patients are poorly informed when they seek bariatric surgery as medical tourists. They do not consider the far-reaching implications of having complex gastrointestinal surgery for morbid obesity (a chronic disease) in a foreign country and they have made no plans whatsoever for appropriate, informed follow-up care.

I will not fall into that category. If I do this, I will be well informed, and I will absolutely have plans for follow-up care.

The article also includes this:

In terms of quality of care, there is certainly data to suggest that some overseas centers have equal, if not superior, results for certain procedures. The peri-operative mortality rate after coronary artery bypass surgery at the Escorts Heart Institute and Research Center in India is .8%, less than half the rate of most hospitals in the United States.

I'm sure many people would find that statistic surprising.

I would like to read more unbiased comparisons of safety, but so far I've only found the one. Most information is written by clinics -- either Mexican clinics saying how great they are (worthless) or American, for-profit clinics scaring potential customers away from Mexico (also worthless). A clinic in Dallas claims "Our doctors are highly educated and regulated, with national and state licensing boards ensuring everyone on the medical team is qualified for practice. Other countries might not have as stringent educational standards or be as thorough with regulations." That's just an unsubstantiated claim. Anyone "might" have anything.

I'm not sold on Mexico, but I'm leaning towards it.

* A decade-long lawsuit challenging this came to a close in February 2020. A Supreme Court decision is pending.