First trip to the Dr to ask for a referral

I'm going to my Dr today to ask for a referral to the Ontario Bariatric Network. I don't know why I'm so nervous. I'm pretty sure I qualify and fit the criteria (so far) 5'10 cw 310lb with hypertension and prediabetic. I've never been one to worry about how to approach something before yet I'm worried and concerned about what i'm going to say to him.

Hello,

Congratulations on being brave enough to make the appointment to have the discussion. My doctor brought it up to me and moved back in his chair. I asked if he thought I was mad at him for bringing it up or thought I might hit him. We both laughed. It's a sensitive subject for everyone, yet if he or she was talking to us about solutions to manage diabetes, it would be okay.

I would just say that I have tried many other ways to lose the weight and continue to struggle. That I have done research and know the programs in place are there to ensure success and that the work begins far sooner than the surgery. That you would like to attend the orientation and proceed from there so you can assess if this is the right choice for you as a step towards better health. Some people have resistance from their G.P.; this was not the case for me nor do I believe it is the case for most patients.

Ask the question - you will do well. Keep us posted.

Linda

Do not be afraid to advocate for yourself. My Doctor was hesitant but I was fed up with my weight and pushed.

I found this under the resources tab here, it is a letter for insurers to assist people in the states wanting surgery.

It lists a number of reasons to pursue the surgery and will help you make your case for him to complete the online documentation required.

obviously take what applies to you, I copied and pasted because I hate links.

Use any of the comorbid conditions if it applies to you.

Use any of the diet plans that apply to you, in this case failure for a diet plan and the ability to keep the weight off for a time period after increase your candidacy.

Start:

I am _____ft_____inches tall and I weigh _______pounds. My body mass index is _____. Therefore, I am classified as being very severely obese. With my abnormally high BMI, I am at an estimated _____ percent increased risk of death at my present weight.

I ask for your referral to the bariatric network.....

I am having significant adverse symptoms from my obesity. I have difficulty standing and in doing any kind of exercise, even walking more than a short distance. I have difficulty performing any daily activities and in participating with my family in recreational activities.

I suffer from stress incontinence and have to wear protective pads at all times. A large heavy abdomen, and relaxation of the pelvic muscles, especially associated with the effects of childbirth, may cause the valve on the urinary bladder to be weakened, leading to leakage of urine with coughing, sneezing, or laughing. This condition is strongly associated with being overweight, and is usually relieved by weight loss.

I have sleep apnea. Sleep apnea ? the stoppage of breathing during sleep ? is common in the clinically severe obese. The health effects of this condition may be severe. It has been estimated that up to 50 percent of sleep apnea patients have high blood pressure. Risk for heart attack and stroke also increase in those with sleep apnea. People with sleep apnea often feel very sleepy during the day and their concentration and daytime performance suffers. The consequences include depression, irritability, sexual dysfunction, learning and memory difficulties, and falling asleep while at work, on the phone, or driving. This condition has a high mortality rate, and is a life-threatening problem. People are usually cured of sleep apnea by this surgery and the permanent weight loss it brings.

I have sleep disturbances and one doctor suggests a sleep study for sleep apnea. The weight loss would help with sleep disturbances and cure sleep apnea.

I am diabetic. In addition to being a morbid and lethal disease, diabetes has been shown to be very expensive to treat. Gastric Bypass has been shown to cure diabetes and prevent its complications.

I also suffer from high blood pressure. Essential hypertension, the progressive elevation of blood pressure, is much more common in obese persons, and leads to development of heart disease, and damage to the blood vessels throughout the body, causing susceptibility to strokes, kidney damage, and hardening of the arteries. If hypertension is not under control, many complications can occur as a direct result of continued high blood pressure. Sixty percent of hypertensive people are obese. The weight loss attained by gastric bypass surgery will cure hypertension.

I have gastroesophageal reflux disease (GERD). This condition is dangerous, because of the possibility of pneumonia or lung injury. The esophagus may become scarred and constricted, causing trouble with swallowing. Approximately 10?15% of patients with even mild sporadic symptoms of heartburn will develop a condition called Barrett's esophagus, which is a pre-malignant change in the lining membrane of the esophagus, a cause of esophageal cancer. Pathologic conditions associated with GERD include erythema, isolated erosion, confluent erosions, circumferential erosions, deep ulcers, esophageal stricture, replacement of normal esophageal epithelium with abnormal (Barrett's) epithelium, pulmonary aspiration, chronic cough, and reflux laryngitis.

Also, I have hypercholesterolemia (high cholesterol). When there is too much cholesterol in one's blood, the excess can become trapped in the walls of one's arteries. By building up there, the cholesterol helps to cause hardening of the arteries or atherosclerosis. And atherosclerosis causes most heart attacks. How? The cholesterol buildup narrows the arteries that supply blood to the heart, slowing or even blocking the flow of blood to the heart. So, the heart gets less oxygen than it needs. This weakens the heart muscle, and chest pain (angina) may occur. If a blood clot forms in the narrowed artery, a heart attack (myocardial infarction) or even death can result.

Arthritis is a major comorbid condition that I have. One of the nearly intolerable problems is the constant pain of the weight-bearing joints. An increase in body weight adds trauma to weight bearing joints and excess body weight is a major predictor of osteoarthritis. This is a mechanical problem and not a metabolic one. The hips, knees, ankles and feet have to bear most of the weight of the body. These joints tend to wear out more quickly, or to develop degenerative arthritis much earlier and more frequently, than in the normal-weighted person. Eventually, joint replacement surgery may be needed to relieve the severe pain. Unfortunately, the obese person faces a disadvantage there too ? joint replacement has much poorer results in the obese. Many orthopedic surgeons refuse to perform the surgery in severely overweight patients. The permanent weight loss of gastric bypass surgery will markedly decrease problems with arthritis and the ever-increasing expenses to the insurance companies that will surely follow.

I suffer from venous stasis disease. The veins of the lower legs carry blood back to the heart, and they are equipped with an elaborate system of delicate one-way valves, to allow them to carry blood ?uphill.? The pressure of a large abdomen may increase the load on these valves, eventually causing damage or destruction. The blood pressure in the lower legs then increases, causing swelling, thickening of the skin, and sometimes ulceration of the skin. Weight loss after gastric bypass can relieve venous stasis disease.

Because of my weight, I am depressed. Seriously overweight persons face constant challenges to their emotions: repeated failure with dieting, disapproval from family and friends, sneers and remarks from strangers. They often experience discrimination at work, and cannot enjoy theatre seats, or a ride in a bus or airliner. It is no wonder that anxiety and depression might accompany years of suffering from the effects of a genetic condition ? one which skinny people all believe should be controlled easily by will power. I suffer from depression related to obesity and I am on _________________ to treat it.

Coronary artery disease is another problem caused by clinically severe obesity. Severely obese persons are approximately 6 times as likely to develop heart disease as those who are normal-weighted. Coronary disease is pre-disposed by increased levels of blood fats, and the metabolic effects of obesity. Increased load on the heart leads to early development of congestive heart failure. Severely obese persons are 40 times as likely to suffer sudden death, in many cases due to cardiac rhythm disturbances.

I become short of breath on any exertion. I cannot climb even one flight of stairs without stopping, and have a very difficult time performing the ordinary day-to-day duties of living, such as shopping, cleaning, getting in and out of a car or chairs, or to board a bus. I was once physically active, playing sports and enjoying gardening, but at this time I find that I am unable to perform any recreational activity, and feel depressed because I cannot control or lose the weight. Climbing stairs or even walking short distances causes the obese person to become very short of breath. Obese persons find that exercise causes them to be out of breath very quickly. The lungs are decreased in size, and the chest wall is very heavy and difficult to lift. At the same time, the demand for oxygen is greater with any physical activity. This condition prevents normal physical activities and exercise, often interferes with usual daily activities, such as shopping, yard-work or stair climbing, and can be completely disabling. Losing weight will cure respiratory problems.

I have been diagnosed with Obesity Hypoventilation Syndrome. This condition occurs primarily in the very severely obese ? over 350 lbs. It is characterized by episodes of drowsiness, or narcosis, occurring during awake hours, and is caused by abnormalities of breathing and accumulation of toxic levels of carbon dioxide in the blood. It is often associated with sleep apnea, and may be hard to distinguish from it. After gastric bypass and the weight loss it brings, OHS will be relieved with weight loss.

I have chronic skin problems. I am in a constant battle with yeast infections and chronic rashes in the folds of my body. The obesity causes these skin folds so that skin rubs on skin and the moisture trapped in those creases causes the infections and rashes.

I have made many attempts to lose weight, including:

Weigh****chers
Weigh****chers
Jenny Craig
NutraSystem
Herbal Life
Atkins diet
Mayo Clinic Diet
Nutritionist consults
Hypnotism
Acupuncture
Gym memberships
Richard Simmons
Redux
Meridia
Phen-fen
Xenical
Pondimin
...and many of the over-the-counter diet plans and diet medications.
I have included exercise with all weight-loss attempts. I can lose some weight, but then I gain it all back and more. There is not one study that shows that dieting brings permanent weight loss. The National Institutes of Health, in 1991 and 1992 consensus statements, rebutted conventional diets for morbid obesity, and pointed to this important fact: Diets alone cannot be successful for the morbidly obese.

Most of these, as is evidenced in my case, are not effective. Rather it can be expected that I will continue to gain weight over the ensuing years and add to this present list of obesity associated illnesses.

Seriously obese persons suffer inability to qualify for many types of employment, and discrimination in employment opportunities, as well. They tend to have higher rates of unemployment, and a lower socioeconomic status. Ignorant persons often make rude and disparaging comments, and there is a general societal belief that obesity is a consequence of a lack of self-discipline, or moral weakness. Many severely obese persons find it preferable to avoid social interactions or public places, choosing to limit their own freedom, rather than suffer embarrassment.

I do not want the surgery just so I can look great. I need it for health reasons, as you can see. I ask that you pre-approve this surgery so that I can become a healthy, productive person once again. Thank you very much for your consideration.

Good luck! I can completely sympathize with the anxiety to ask. I just found the OBN thanks to another helpful post and was made aware that I would require a referral. My family doctor is very good friends with my mother and I am not confident that she will keep my information confidential (crazy I know, and time to switch doctors). I'm wondering however if I'll even be considered as although I am 5'6 and 220 lbs, I do not have any of the listed co-morbidities. Does that automatically make me ineligible? Wishing you good luck and that their response is favourable!

I went this morning and the Dr was very supportive. I didn't need to get into much with him about why I wanted it. He thinks I'm an excellent candidate for the surgery though.

He has never referred anyone to the OBN before so has to create an account which he said he'd do this afternoon after the surgery closes.

I know the first step in the process is orientation but I'm not sure at what point someone tells you if you've been accepted to the program/wait list and you are eligible for surgery?

ive also no idea on timescales. It doesn't help that I currently live in Markham but I'm moving to Sudbury in July (4hrs north of me). I hope that doesn't cause issues with my referral.

Follow-up with your Doctor, to make sure he has completed the referral, and then try to contact the network to confirm receipt. I did not do this and trusted all was well and this added to my wait time.

Congratulations on having the conversation with your doctor!

My doctor referral me to the OBN a few weeks ago. He was able to give me a printed confirmation on the spot the I qualified for at least the first stage! He was also able to select my hospital at that time. I'm in Mississauga so we selected TWH.

With your upcoming move, I don't know if it makes more sense to start at TWH and then transfer your file to Sudbury, or request that you start there. You can try calling OBN for advice, asking your doc, or maybe someone else here knows.

Good luck!

I know it probably made more sense to wait until I move but I didn't want to wait a few more months and finding a new family dr you're comfortable enough with to talk to them about this kind of thing isn't an easy task so it could have been 6 more months.

Ii will be calling to confirm he sent the referral though in case he forgets to do it (he has t ever given me the impression he'd do this but I'm paranoid). He did say he thought I was a good candidate and with a BMI of 43.3 i fit but I also have comorbidities so it makes it even stronger a case. I just hope the OBN accept me for it.

I didn't need to call the Dr's office as they called me to confirm they'd submitted the registration and to advise me to keep my phone nearby so the OBN can call with my appointment details (whatever that means lol).