Met Dr. Pop today

My mom & I drove to Detroit on Sunday from Ottawa - took waaaaaaaaaay too long but we hit snow flurries (and other various frozen precipitation) on the way down and in the end, we spent almost 11 hrs on the road to get there. The Red Roof in was clean by very basic - not sure I'd like to spend 4-5 nights there but at that cost - I may have to reconsider. {giggle}

We decided to get up and head straight to Barix Monday a.m. to check in and it was barely passed 9am and we were the 2nd to check in. Whew... We headed out to find breakfast and grabbed McD's - can I just say that eggs on a biscuit is sooo much better than on an English Muffin (are you listening McD's Canada?)?? OK - then we had fun playing with Trixie (what we called the GPS in Mom & Dad's new car) and were able to find a TJ Maxx about 5-10 min drive from the hospital. So we killed about an hour at TJ Maxx and then headed down the same road to Target & Lane Bryant - bright new stores. Found a blouse at Lane Bryant for the Christmas Tree (finally) but was quite disappointed in myself at how small a size 26/28 felt - many wouldn't go over my hips. Yikes.... (although I look around at my group sessions and the consult today and wonder where these folks who are bigger than I am get their clothes?).

Having gotten what we needed (and being mindful of how much we could bring back across the border), we decided to grab a quick lunch before heading back to Barix. IHOP - wow!! 2 poached eggs and 2 pancakes with 2 bacon. To be honest, I was at first wondering "where's the toast!" but in the end, it was the right amount of food. And for the first time in awhile, no pop with my meal - just water. Felt good actually. Yep - I guess that's maybe my first mini-wow on this journey?

Back to Barix to fill in all the paperwork - medical history, etc. At 1:15, they came out to collect us and we had our group consult with Dr. Pop. He's really nice - if I met him at a social function, I would want to be friends with him. Pulls no punches but has a good sense of humour, etc. As odd as it sounds, he seems to have a twinkle in his eye that lets you know he's a fun guy when it's appropriate. :) Mom thought he was pretty "neat" too.

We broke into 1:1 sessions around 2:30 or so - I was pretty darned happy to be #2 on the list. I was called fairly quickly - height (5ft 5.5"?? She squished me pretty hard - I'm at least 5'6" - I used to be 5'7"!!), weight (325), BP (seemed ok - maybe on the higher side of normal but ok), etc.

Met with Dr. Pop - apart from my apnea, no co-morbidities. He asked which surgery I felt I wanted and when I said the sleeve, he didn't even blink. Not sure if he was going to suggest RnY or discuss the pros & cons but I think I told hime that I'm just not a sweets gal - I have maybe one day a month where I really really crave sweets but it's around that time of the month and I can be satisfied with 1-2 cookies now and I'm sure that would be less if I couldn't eat as much. I honestly feel that I need help with portion control and improving my food choices and none of the surgeries would really help with the food choices per se.

I don't need any more testing - don't need to meet with psych, no need for cardiology, etc. We did talk about post-op and caring for Andrew but he's more concerned about my eating to soothe, esp. if I eat to soothe as a coping mechanism for the stresses (and he said that having child with a disablitliy is stressful - nice to hear him say that) in my life.

We left about 3:30-3:45pm and had no troubles clearing the border - I've had longer lines here in Ogdensburg! (but man the Ambassador bridge is a mess right now - I'd hate to see it on the weekend when more folks are travelling) The drive was good - moving right along until we hit St. Thomas (just outside of London) around 6pm or so and we had snow - not just snow but a WHITEOUT. The transport in front of me disappeared completely. So we got off at the next exit and had dinner and tried to wait it out (and hoped it would ease) and thankfully it did. We were back on the road around 6:45 or so and it was pretty good the rest of the way - a few snow flurries around London itself and then clear sailing.

Mom dropped me at Pearson Airport in Toronto around 8:25 or so, I got my boarding pass and headed to the gate to chill out and wait. We were a tad late boarding but the flight was only 1/3 full so it was quick to board and I think we pushed back right on time (or within 5 min of our scheduled time). We arrived in Ottawa on time and I met up with my friend Stephanie within minutes and she was shephearding me back to my house.

Was nice to be back in my own bed!!

Signed my OOC (out of country) paperwork for the Ontario Health Insurance Program (OHIP) at 10am this morning and it was faxed off while I waited! Woot!!

So now I wait - I would love to hear before I meet Dr. Pop on the 17th but that's only really a week away as I imagine my file won't be looked at today however I have heard of approvals in a week so maybe.

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.

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