Today's BMI appointments...

Had an appointment with Shawna (the NUT - well ok, she's a dietician but saying "nut" as in nutritionist is that much faster - ok Shawna?) at BMI this afternoon. I very proudly showed off my food journal. For the first time since last fall when I first "joined" BMI, I have been much more faithfully filling out my food journal. Honestly - this has indeed allowed me a better picture of what I'm eating and being honest about when I snack, etc. It's not perfect but it's a start. Shawna was very pleased. :)

For now, my goal is to continue my food journal and making sure I eat my 3 snacks & 3 meals aiming for my 100+ g of protein a day and approx 1700-2000 cal/day. I find the a.m. snack the hardest to remember - eating breakfast at 8am and then lunch around 11:30, I don't feel I need one in between but I'm working on eating something less filling like nuts at that time.

Also got to talk off the record with Dr. F about my findings, etc. He originally was pushing (well - not pushing per se) for me to consider the DS but after doing my online reading/research, he also feels that my familiy situation does not allow for me to be out of commission for 10 weeks post-op if I have the DS (which is done as an open procedure when covered by OHIP). The lap surgery (either VSG or RnY) is a shorter recovery. I have to confirm with Dr. Pop the exact timing but it is certainly a shorter recovery in that sense.

I shared with him some of what I learned about vitamins and such from my OH Ottawa group meeting on Sunday. He is familiar with the DS procedure but I find he's always very open minded and wants to keep up with what's out there. I thought Shawna (the NUT) would also want to keep abreast of what folks are doing post-WLS.

On a personal note, I am already starting to notice that I am worried about how I will feel/look after the weight starts to come off - to the point that it's affecting my self confidence already. Not great but an early demon that's rearing it's head. I will definitely be investigating the counsellor at BMI to discuss these issues BEFORE I have surgery so I have some better coping techniques for the ups & downs post op.

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Today is the first day...

Wow - a brand new start. A blank page can be overwhelming but I'm jumping right in. This week has started me down a new path to a new & better me.

I met with Dr. F on Monday and we once again discussed my difficulty following a weight loss program and he asked when I would put up the white flag and say enough. And I think I am finally ready to admit that I need a stronger tool to help me get to my goals and to be a better & healthier me.

He pointed me to a website where he knew I could find others locally that have faced the same demons and so I spent far too much time this week on the Obesity Help boards. I had previously done very light research into the available surgical options in June and I wasn't ready.

This time, I have read over the differences between the Roux-en-Y or RnY (what you might know as the Gastic Bypass), the Duodenal Switch (DS) and the Vertical Sleeve Gastrectomy (VSG). There is a lot of information out there and each person has their own opinion of what they feel is best and they push their own agenda so it's sometimes a hard read and I tried to come up with impartial information to help me make my own decision.

The RnY and the DS surgeries are both restrictive (reduced stomach size) and malabsorptive (due to the rerouting of the intestines, the food/minerals/vitamins aren't always properly absorbed). Both of these surgeries require vitamin supplements for the rest of your life and medical follow up regularly to ensure that you are not malnourished, etc.

The RnY removes the pylorus (which means that it no longer controls the movement of food into the intestines). This can, in many patients, cause "dumping" when too much sugar or fat hits the intestines. Another side effect can be ulcers in the new pouch (what remains of your stomach). Because of the change in anatomical structure to the stomach, ulcers can be hard to see/diagnose. NSAID drugs (like aspirin or non-steroid anti-inflammatory drugs) are therfore contraindicated for those who have had RnY surgery.

DS surgery, on the other hand, while restrictive in nature keeps the pylorus so that DS patients do not experience “dumping”. And because the stomach is not restructured in the same way as the RnY pouch, ulcers are easier to detect and NSAIDs are not restricted.

The VSG is similar to the DS as it relates to the stomach & pylorus. It is a restrictive surgery only and the intestines are not touched avoiding the malabsorption. It can mean a slower weight loss however good results can still be achieved.

The statistics relating to the amount of excess weight loss below come from the DS Facts website:

RNY
EWL% at 1-2 years 48%-85%
EWL% at 3-6 years 53%-77%
EWL% at 7-10 years 25%-68%

DS
EWL% at 1-2 years 65%-83%
EWL% at 3-6 years 62%-81%
EWL% at 7-10 years 60%-80%

The statistics for the VSG at 2 yrs post-op have been found to be similar to the RnY and the DS (81-86% EWL%).[1]


At this time, I have not yet made up my mind which of the 3 surgeries I will be pursuing in the next year. At this time, I am leaning towards either the DS or the VSG. With a BMI of 50 and what they call a co-morbidity (sleep apnea), I should be able to have OHIP (the Ontario Health Insurance) program cover the costs of this surgery out of country (OOC). Because there are a very few doctors in Ontario doing any of these weight loss surgeries (WLS), more & more Ontarians are going to NY or MI for surgery. Travel & hotels costs are up to the patient but all medical costs are covered. OHIP only covers the cost of ONE consultation however so before I put in my paperwork that will limit me to one surgical procedure, I am doing my due diligence.

On Friday (Oct 24th), I called Dr. P in Detroit who will do the VSG and is an approved OHIP provider. I have a free consultation with him on November 17th so that's a start. I have a large amount of DS information from the folks locally who have seen Dr. L in Detroit but there are very few who have had the VSG and I want to ask him all my questions before deciding on the VSG vs DS.

Also, OHIP will only pay for the DS when done as "open" surgery while the RnY and VSG can be performed laprascopically. The open surgery requires 4-5 days in hospital post-op while the lap. surgery is 1-2 days. With 4 kids at home, this plays very heavily into my decision.

I'll be documenting my journey as I meet with the docs, make my decision, get OHIP approval and then getting a surgery date.



[1] Dr Lee, Jossart and Cirangle