complicated question???

I live in Toronto, and I am on the bariatric list.  On june 25th, I had a self paid sleeve, because I didn't want to wait anymore (I already had been waiting 4 years in Québec so was not willing to wait another year in Ontario).  But I am still on the bariatric list.  I have received a letter for a sleep study, at st-Micheal. 

I do not know which center I am with, I do not know who to call for questions, I thought I would have an information session prior to anything else, no???  Anybody know where I should call for information???

My complicated question is the following:  I am now a BMI 35.  Before my surgery (and when I was refered for surgery) I was 54.  Still being on the bariatric list, I was wondering if I would still be able to get a DS (I had a sleeve).  I have no complications, nothing.  I am still losing but really thinking about this DS (that was for me the plan back in QC, they do the sleeve than you have the choice to go for the DS or just stick with the sleeve). 

If I am not clear or if you need more details to answer, please let me know!

Karine.

Karine,

You can email the registry to ask which centre you were assigned to.  You will get an auto reply saying they won't answer but within a day you get an answer.  Give them as  much detail as possible like full name and address with date of birth and health card number.

 [email protected]

Once you find out which centre, you could then call and talk to them.  Not sure if you would qualify with a BMI of 35 as that is the cutoff with co-morbidities to even be considered for any WLS in Ontario.

Thanks for the email. I will try to contact them

I know my BMI now is too low, but I was under the impression that it was the BMI when I was refered that counted?  But then I had surgery...

We will see, it is not such a big deal, sleeve is working well, but this might be my only chance to revise to DS free of charge. 

It's only been about 6-7 months since your surgery, your BMI is under the required minimum... Sorry to disappoint you Karine, but it is extremely unlikely that you get revision to full DS in this situation, especially in Ontario - we don't have the luxury of choice here, we have "golden standard".

But, aren't you the one that posted this:.

It i done as a "first" surgery, though, there is only one surgeon in Ontario, doing this surgery - Dr. Hong in Hamilton, he does VSG first on heavy weights, with conversion to DS as an option, but did full DS on a few people with lower BMI.

I am not sure I understand the difference...sorry!

Dr Hong is at St. Joe's Hamilton, where I am and I know that he has told several people here lately that the Ontario government is cracking down and it is very hard to get approval of DS. You would get weighed at your first appointment after orientation and that will be the weight they use to determine if you qualify--It's different in the U.S.where the referral goes to your insurance company.

The situation of people with "lower" BMI having DS. Essentially, it usually means people with high but not "super obese" BMI and few complications--DS is a much more difficult surgery with higher short-terms complications (often because the surgery takes about 6 hours instead of 2)

Obviously, you can do what you what but my belief is that you would have almost 0 chance of being approved

Good luck whatever you decide

thanks for explaining the `lower BMI`.

That`s exactly what I meant  - high, i.e. over 40, but not `super obese` - not 60+.

The difference is that so called two stages DS (VSG + switch later) if performed by Dr. Hong when a patient is approved by OHIP for the DS surgery, but high BMI or current health condition prevent surgeon from performing a full operation - it is a longer procedure than any other wls, and the intestinal switch is performed on the most fragile portion of intestine, hence it is considered higher operative risk, especially for people with complications or very high BMI. the ``two stages`` is reserved for them. In Ontario the ``Second stage` - the switch, is not offered to anyone by choice, only if deemed as a medical necessity.

In your case, you are not approved for DS in Ontario. For OHIP you`re just starting the process and being only 7 months postop, actively losing weight and already with BMI of 35 - you do not qualify for any additional surgery at this point. You might qualify for postoperative consultations, follow up or something like that, but doing the full DS would be considered a revision. It can be done, it is covered, in case of failure or complications. BMI of 35 at 7 months out is not a failure, it is a success. You mentioned that you don`t have any health issues... Sorry, but just as PatXYZ said - you don`t qualify at this time, sorry to disappoint you.

I was told that Dr Hong is the only Dr in Ontario that does the DS, I have several friends with or in the process of the DS, and all but one had the sleeve first.  If you can make your case with him, he may approve you, but I have also heard that they are cracking down.  Also, I believe that revisions have a waiting period, to make sure that you maximize your weightloss with the sleeve first.

They won't even consider revising you until they see that you have 'failed' your VSG. That would mean a BMI of 35 or higher at 2 years, or more, out of surgery with no loss even when following the program. I would ask them to cancel your referral. If you need it again in a year and a half you can be re-referred. Right now you are just taking up a spot for someone who needs their first surgery.