A Word About Poop, Plus Better Information From Canada

I've left out part of my recovery and adjustment story: information about bowel movements. That's what happens when you know friends and family are reading! It's a bit embarrassing to share my poop stories with them!

But as I always say, this blog is for myself -- and it's also for anyone else who is considering or has had bariatric surgery, who might stumble on it. I've already heard from some readers who are in that category.

So with that in mind, here is a word about poop! Obviously if you are free to skip this part.

The part about poop... in case you want to skip it

When I caught up with WRD after the surgery, she asked, How are your bowel movements? And I answered, "I haven't had any, because I've been on a liquid diet for so long," as if this was the most natural thing in the world. I can't remember what she said... we just moved on.

Two days later, I had very intense gas pains and cramping, the worst I've ever experienced. Only then did it occur to me that I hadn't had a bowel movement in three weeks! Probably not good, liquid diet or no. (A friend who is a medical professional, and who has had multiple surgeries, told me that anesthesia can have that effect as well.)

This pain went on for hours. I was nauseated, sweating, just absolutely in agony. I had Gas-X, which the hospital had told me keep on hand, both before and after surgery, but it didn't do very much.

I sent my partner to the drugstore for Senokot, as I know that's supposed to be a natural product and more gentle than something like Ex-Lax. 

I took some Senokot, then was exhausted from the pain and went to sleep... and woke up in the middle of the night, racing for the bathroom. It was disgusting, but I did feel much better afterwards.

I told WRD about this, and she asked if I was taking my Colace. Say what now? 

She said that on the checklist for bariatric surgery (meaning the information from the Canadian province where I live), it says I should be taking Colace, a stool softener, every day. We bought some at our local drugstore and I've been taking it since. It's also a gentle product, and can take several days to work.

Since then, I've had two bowel movements, but I would say I am still constipated. This is definitely on the list of potential side effects from the surgery, so I will continue to monitor it. Another bit of data to add to my food diary! 

The part about the information

This experience brought up something else, too: I was missing information. 

Before my surgery, WRD asked if I had the information booklet from our public health care. I thought I did... but what I actually had was a booklet for the orientation process. It was more general "what you can expect" information. 

The Colace incident made me realize I did, in fact, have the correct booklet. WRD sent me the full provincial booklet -- and it was so much better than what I had from the hospital! This does not surprise me. It makes sense that a public health program is going to be much more detailed and have better information than a private clinic. 

On the other hand, the dietitian that works for Oasis of Hope Bariatrics, where I had the surgery done, seems not to understand the concept of advance planning. Pre-surgery, I had to practically beg her for the diet plan. If it had turned out I needed to order Optifast, as I thought I did, I could not have bought it in time. 

Similarly, she would not give me the Phase 3 diet until the day I was ready to start that phase! She said she does this so patients won't start early. But what about planning and shopping in advance?! The day I was supposed to start taking post-surgical vitamins, she sent me a link to where I could purchase them! 

The information from our province had a checklist of everything you should buy in advance, including the vitamins, so everything is on hand when you get out of the hospital.

WRD gave me the full run-down on vitamins, and I purchased some locally while I wait for a shipment from my preferred online vitamin store. This meant I started the vitamins five days late. I'm sure I won't become malnourished in five days, but it was disappointing.

The provincial booklet is also better all around -- more detailed, written more clearly, and better designed (more accessible). Again, this does not surprise me, but I'm disappointed I didn't have this all along.

If you're in the US and you end up having weight-loss surgery done privately, you'll want to advocate for yourself with the clinic's dietitian, or if you're able, get in touch with a dietitian on your own. 

Recovery Day One: Time To Break Out an Old-School Cliche

Well, it's done! This morning I am thinking of that very old poster cliche, Today is the first day of the rest of your life. I've made this permanent change, and it feels daunting, but I will continue to take it step by step.

Monday night I was prepped for surgery, including an IV line for hydration and follow-up medication. Then yesterday I had visits from a whole slew of medical staff: the surgeon, the anesthesiologist, the doctor who coordinates my care, the patient coordinator who I've been emailing with, and a nurse. The dietitian even came by to say hi and tell me we will speak tomorrow.

They gave me a chest x-ray, an EKG (normal! whew!), compression stockings, and maybe some other things I've forgotten. 

Then I was wheeled off, needle, drowsiness... then I was in my room. Ta-da!

I woke up feeling like I'd done 1,000 crunches, with pain under my ribs. Apparently laparoscopic  surgery pumps you full of gas. Ouch. 

Once I woke up more fully, the doctor visited again, saying the surgery was fast (45 minutes) and easy. He told me to walk around as much as possible, as this will help the gas dissipate. Also, I have a drain (TMI?) that they will monitor, plus a breathing thingy to help facilitate deep respiration... also for gas.

So I spent the rest of the day alternating between sleeping, walking around the room and in the hallway, and having nursing staff come in and out putting various medications in my IV line -- anti-nausea, antibiotics, anti-gas, painkillers -- and giving me ice chips.

IV lines! Why wasn't this always standard?! When I was 12 years old, I had knee surgery. All painkillers and antibiotics were given by injection into my thigh. Always the same thigh. After a while, it hurt so much that I was crying, and preferred the surgical pain to the constant stabbing. It also caused nerve damage; the area was numb for nearly 20 years! Why didn't they use an intravenous line? One needle, and you're done.

I can tell that the standard of care here is very high. The staff is very methodical and deliberate, with great attention to detail. Perhaps this is a function of working in a private clinic without a huge number of patients? I don't know. But my experience in hospitals, either for myself, my partner, or anyone I've ever visited, has been that staff are very rushed, and if you don't advocate for care, it's easy to be overlooked. (Admittedly my experience is limited to New York City, where everything is always over-crowded and rushed, and the same, but slightly less, in suburban Mississauga.)

You may be wondering about a language barrier. The doctors all speak perfect English and are obviously fully bilingual. The people who seem to be the head nursing staff speak a lot of English; they also use translation apps on their phones, for both you and them to speak in. The aides don't have much English, but instead get someone for you who does. 

Everyone is friendly and so caring. It's like this in BC, too -- medical staff are unfailingly friendly and caring. I did not find this in NYC or Mississauga! I'm guessing, again, that's it's down to workload. It's hard to demonstrate caring when you're constantly rushed off your feet. 

So it's morning now. Today will be full of breathing tests, walking, drains, and other recovery business. The doc told me there are three different tests for leaks. If any are found, it's back to surgery to repair them. However, he informed me, his work never leaks. The hospital's complication rate is less than 1%, and his is zero. (Surgeons!)

To be honest, I don't know how I will be ready to travel tomorrow afternoon, but then again, that is more than 24 hours away. I already feel better this morning than I did yesterday.

One weird thing: I had an allergic reaction to one of the medications. My face and lips got swollen and puffy. No respiratory issues -- my breathing was not affected, only my face. My lips look like I tried to give myself silicone injections and didn't read the instructions. They gave me antihistamines, and will change both the nausea meds and the painkillers.

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?

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.

I Am Considering Having the Surgery Done at a Private Clinic

I've been researching the options for having bariatric surgery done privately, outside of our public health care system. The big consideration -- actually, the only consideration -- is money. It is very expensive, far more than I should even be thinking about. 

I recently had a small surgical procedure done, and I had to be weighed for the anesthesia. I was both shocked and not at all surprised to see I have gained yet more weight. 

Shocked, because I haven't been on a scale in more than two years, so seeing the number was a shock. 

Not surprised, because this is what my body does. Despite any steps I have taken or will take, I gain weight.

At this point I feel that my weight is diminishing my quality of life. I am becoming increasingly less mobile. More and more health issues are popping up. I'm sure that surgery is my only option. But surgery in this province is easily two years away -- or more.

I could have the surgery done in another province (on the other side of the country), right away, no waiting, if I'm willing to spend an extremely large amount of money. I would have to finance it, so I'd have yet another bill to pay. We are currently paying off a short-term (no interest) loan that ends in December 2021. Financing part of the surgery would make next year's finances even tighter. Although not impossible. 

The private clinic sees people from all over Canada, and they can arrange it so there is only one trip, for the surgery itself. Tests and whatever medical prep is needed can happen locally, and consultations can be done by videoconference.

What if I have the surgery done privately, incur all that expense and debt, then the Province announces a new policy, and they clear the bariatric surgery waitlist? That would suck!

I already know I want the surgery. I don't know if I should do it financially.

I also know this is not a question anyone else can answer for me.