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. 

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. 

Bye For Now, Until There's News To Report

I don't want this blog to turn into a diet-and-exercise blog without the surgery. So I'll put this space on hold until I get some news on the surgery. You might want to subscribe by email, so you'll receive a notice when I'm back.

Thank you for your support and encouragement. I really appreciate it!

After That Shock, Next Steps

It's taken me a few days to get past the shock and disappointment of learning that bariatric surgery is years away. Now I'm left with serious concerns about my health.

The RD in our local health centre showed me that the best way to reduce my blood sugar levels is to increase my exercise. And of course increasing exercise is good for so many other reasons. I'm 58 years old, overweight, and there's cardiovascular disease in my family. Enough said.

The habit itself is not the issue. An exercise routine had always been part of my life, until about 10 years ago. I'm motivated and ready to change that.

The issue is what and how.

One of my goals or desires has been to spend more time outdoors, which is not always easy when you're a bookworm and completely non-athletic like me. I love to walk and hike, and I've been trying to maximize that.

But walking is so weather dependent! I thought I would buy good rain gear and walk in all weather, but that just hasn't worked out. I just really don't like being out in the rain. Plus, for a good portion of the year, at my preferred time to exercise, it's dark outside.

I'm swimming again, but until/unless the pool in our tiny town opens early in the morning, that's only once or twice a week, at best -- and many weeks, not at all.

There is a gym in town, so that's an option.

Right now I think getting some exercise equipment for our own home is the best option. In the past, at different times we've had a cross-country machine, and a manual treadmill, which I used to rotate with swimming. I'm going to start investigating.

As far as writing this blog... I'm not sure what I'll do.

Why Are Wait Times for Bariatric Surgery So Long? Bias.

I saw this article when I was first researching weight-loss surgery, so I knew there had been a 24-month wait list.

But when I looked deeper, I saw Health BC showed very low wait times. The local RD confirmed that. A few times, my partner and I said to each other, so what happened to that long waiting list? .... It seemed to have disappeared.

But no.

The story criticizes BC Health's decision to cap the surgery at 400 per year.

Sheila Vataiki was struggling with obesity, sleep apnea, atrial fibrillation and high blood pressure, plus taking four medications to control her diabetes.

Her children were convinced she didn’t have long to live, but Vataiki’s problems were beyond her ability to fix.

She got progressively sicker for 10 years before she was finally offered a radical, but life-altering, solution: Bariatric surgery to reduce the capacity of her stomach.

“I had to be really, literally on the verge of death before I could get offered this as an option,” she said.

Since the surgery earlier this year, she has lost more than 100 pounds and every one of her related health problems has vanished.

“This literally changed my life, it gave me back my life,” she said.

Vataiki, now 62, only wishes she could have had the procedure years earlier.

More than 2,500 people in B.C. are waiting to enter bariatric surgery programs to address severe obesity and related health issues, but only 400 will get the procedure this year due to a cap imposed by the Ministry of Health.

“My endocrinologist, who is in the business of treating people with diabetes, can only get two or three people a year into the program (for bariatric surgery),” she said. “Imagine how many people he has that could benefit from this. It’s an incredibly effective treatment.”

B.C. has had some success speeding patients through to surgery once they qualify. There are 75 people on the surgery waiting list, compared with 488 in 2010/11. The median wait time has dropped from 126 weeks to just 4.9 weeks today.

To qualify for the bariatric surgery program headquartered at Richmond Hospital, patients typically must have a Body Mass Index above 35 and a host of obesity-related illnesses, such as diabetes, high cholesterol and high blood pressure, according to surgeon Dr. Sharadh Sampath, president of the B.C. Obesity Society.

All three bariatric procedures — the sleeve, gastric bypass, and duodenal switch — are covered by MSP, if you can get admitted to the program. Sampath’s waiting list is about 1,400 patients, and a similar number are waiting to be admitted to the program at Victoria’s Royal Jubilee Hospital.

Any increase in the cap on surgeries would help manage heavy demand, he said.

Further increases could help patients get the procedure before they are critically ill, in particular diabetics with a BMI above 30, who can benefit, said Sampath.

Per capita, Alberta funds twice as many procedures as B.C., Ontario three times, and Quebec five times as many.

“The disease processes get worse to the point that they can’t be cured by bariatric surgery, or patients are too sick to even have the surgery,” said Sampath.

Diabetics can develop end-stage symptoms such as heart disease or renal failure that could disqualify them for surgery.

“If you are too sick for the surgery, we have missed our window of opportunity,” he said.

There is a compelling business case to be made for raising the cap.

Bariatric surgery and post-operative care costs about $13,000. Vataiki’s medications alone cost $15,924 a year, not to mention all the visits to specialists and a period of hospitalization.

Patients who miss their window of opportunity can end up in our hospitals for months, costing the system millions of dollars, said Sampath.

From the Globe and Mail, May 2018. After a description of the surgery, how much weight the patient is expected to lose, and how his health outcomes will improve...

It’s time to admit what is patently obvious: The western world’s approach to reducing the ever-burgeoning size of its citizens has been a colossal failure. With its emphasis on diet and exercise, this approach has been utterly ineffective in controlling our expanding waists.

Worse, it has essentially shamed the hundreds of thousands of people who are unable to lose weight or fail to maintain weight loss. And fail they do: According to a 2015 study in the Lancet medical journal, up to 90 per cent of patients on a diet-and-exercise regime regain any weight they lost within five years. Yet we continue to offer trite advice and ineffectual platitudes, along with a stern wag of our collective finger at the obese.

This notion is quietly being put to rest in Quebec, home to the largest per-capita number of bariatric surgeries in the country. One in 90 obese people get bariatric surgery in the province, more than double the national average. As home to some of the skinniest people on the continent, and among the lowest per-person health spending in the country, Quebec might seem an odd place to be at the forefront of bariatric surgery research and practice.

Two surgeons, Rae Brown and Lloyd MacLean, were among the first to perform earlier, far more invasive versions of bariatric surgery, at McGill University in the 1970s and 1980s. Most of the advancements in the surgery, including the sleeve gastrectomy and the laparoscopic duodenal switch, were developed in Quebec. Dr. Gagner was the first to do both.

Today, the vast majority of bariatric surgery procedures in Quebec are performed in the private sector, in large part because the stigma against the overweight has become institutionalized within the province’s health bureaucracy.

Quebec is the only province that has paid for all types of bariatric surgeries. Yet, even now, bariatric surgeons have difficulty getting operating time for their patients. “They’ll give a liver transplant to an alcoholic before they let me operate on an obese person,” Nicolas Christou, one of the world’s leading bariatric surgeons, told me recently.

Past health crises have spurred government action. Cancer, among other diseases, has its own society and myriad hospital and governmental research facilities dedicated to its treatment and avoidance. Yet there are no such initiatives with obesity, even though the condition will affect some 34 per cent of Canadians over the age of 18 by 2025, according a 2018 World Obesity Federation report. Instead, we stubbornly believe that the obese are such because of their own failings and overindulgence.

A Big Disappointment

It seems that I started this blog way too early!

I've just had a major disappointment about the surgery.

Looking at surgical wait times online, the wait for bariatric surgery is minimal -- anywhere from 5 to 12 weeks. As it turns out, that is after you've been accepted into the program. Wait time to get into the program: 30 months. 2.5 years.

I'm so disappointed!

Yes, yes, I know I can eat less and exercise more in the meantime. But I also know that will have minimal effect. I will continue to be hungry almost all the time, and continue to be limited in how much exercise I can get, because of other health issues.

The reasons I want the surgery are the reasons that eating less and exercising more is not an adequate answer for me.

Wow. Really sad.