Jiliana2

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I'm going to preface this by saying, "Remember, I'm in Canada, and things here are done very differently in Canada than in the USA. The process is NOT the same."

Now that we have that out of the way...

I live in Ontario. Here in this province, WLS is covered by our provincial health care plan. But you still have to go through the process in order to get there. It starts with a referral. I got my referral to the Ontario Bariatric Registry from my family doctor, my general practitioner (GP). If you don't have a GP, you can get one from a specialist, or a walk-in clinic. It can be done online or your GP can fax the information to the numbers provided.

The Registry receives your information and will assign you to a WLS Centre based on your postal code. There are a few centres around the province. I live in Ottawa, and we have a centre here so I was referred to the Ottawa Weight Management Centre (OWMC) at the Civic Hospital.

The OWMC received my information from the Registry and they sent me a manilla envelope with a questionnaire and an invitation to a general information session. The session was to be held three months after my initial referral from my GP. I highly recommend taking your spouse or a support person to the session with you. More ears are always better! And in the meantime, soak up everything you can on the Obesity Help forums!

Now, here in Ontario, I'm told that three surgeries are covered by our provincial plan. They are the DS, the VSG and the RNY. However, some centres in Ontario (OWMC included) view the RNY as the "gold standard" surgery. That is to say, this is the 'default' surgery that you will receive unless there is a darn good reason why you should have either the DS or the VSG. That reason has to be documented and agreed upon by your surgeon.

For me, I researched a lot prior to even asking for the referral. I found out that with the RNY, taking NSAIDs post-op is a definite no-no. It's not even a good idea for VSG folks really. But I have a huge problem with that, and here's why:

I have psoriatic arthritis. And I have a bad case of it too. My rheumatologist tried a number of medications to control it, when I was diagnosed a few years ago, but only the NSAIDs worked and kept my symptoms under control. There is no cure, only control. So I am taking NSAIDs every single day. And I likely will have to take these for the rest of my life. My arthritis did not go away after WLS and is in my case, related to heredity (many of my family members have psoriasis and psoriatic arthritis) so it's with me for the long haul. NSAIDs are what help me get out of bed in the morning with no stiffness. They help me walk. Without them, I was in a cast before I was properly diagnosed! The NSAIDs are what permit me to go to the gym, get on a treadmill and run for 3 miles without stopping. They're my lifesaver and they help my health. I cannot move, literally, without them for my stiffness is extreme.

So before I met my surgeon, I made an appointment with my rheumatologist and told him of my WLS plan. In so doing, I explained the types of surgeries available to me. I asked him for his thoughts. And he recommended the VSG. It was he who wrote me a note then and there in his office to explain my history, my medical needs and his recommendation for the VSG rather than the RNY so I could continue to take NSAIDs and keep my psoriatic arthritis under control. This recommendation letter was also entered into my electronic health file, and was thus visible to my surgeon when I went to my Meet the Surgeon appointment at OWMC.

Upon meeting the surgeon, he said, "So you want to have an RNY?" and I said, "Yes... but no. I think VSG is the better course of action. Here's why." I told him my history and gave him the details. The surgeon replied, "Well, we'll have to get a letter from your doctor that says that VSG is better." And I said, "I happen to have that here with me and it's in my electronic file too." I pulled out my file folder of previous tests, letters, bloodwork results, etc. (I keep this and take it to every doctor appointment) and he blinked. I think he was shocked that I'd been so proactive on the matter. I simply didn't want to add any extra waiting time before surgery could be scheduled! He read my letter. He looked up my electronic records. And we signed the legal document that agreed that he would do a VSG for me, rather than the RNY (unless something drastic changed during his findings in surgery after he opened me up, of course).

Again, some centres in Ontario are more open to permitting the patient choose. Some offer the VSG as often as they do the RNY. But some, like OWMC, do not. So I advise you do your homework on your particular conditions, your own history, and determine if there is anything there that will contraindicate either surgery for you or indicate that one surgery is particularly more advantageous for you. Do your homework. Be prepared. Know what is required and be aware of what it means in the long run.

For me, having a VSG and taking NSAIDs every day means that I need to have a presription acid blocker (PPI) every morning. I will take this for as long as I need to take the NSAIDs. It protects the lining of my new sleeve and minimizes the risk of my getting an ulcer.

That said, in the USA, things are very different. I like GwenMo's reasons for choosing a VSG over an RNY. Because, yes, in the USA, patients have the choice of surgery type, with input from their surgeons, of course.

(NOTE: The content below was taken from GwenMo's many posts on this topic. All rights are reserved for her.)

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Here's why I chose VSG -- 

The four WLS are - sleeve, gastric bypass (RNY), lapband, and duodenal switch. My insurance covers the first three, but not the DS.

I ruled out the lapband immediately because the only people I know who have had it are miserable or have needed it removed. The complication rate is atrocious and it only lasts for 10 years or so. It's billed as being a "reversible" surgery, but the damage it can cause, like from erosion into your esophagus, is permanent. So no lapband for me. Here's an article on that topic.

The choice really boiled down to RNY or VSG and I chose the sleeve for a number of reasons. (Even if DS had been an option, I would not have chosen it.)

1. I really like the simplicity of the sleeve. All it does is remove 85% of your stomach. That's it.
2. I dislike the idea of having my intestines rerouted.
3. The "good" malabsorption that the bypass gives (of fats) is a temporary thing that only lasts for a few years whereas the "bad" malabsorption (of vitamins and minerals) lasts for forever. That's not worth it to me.
4. The sleeve is restriction only, no malabsorption. This also means that I CAN eat anything at all. Fats and sugars won't screw up my bowels the way they can for the bypass. (Of course I still need to make healthy choices, but that's a choice, not something that my surgery requires.)
5. With the bypass, you're left with a remnant stomach that can't be scoped. That scares the crap out of me. First, the idea that I have this weirdly connected non-stomach but then to not be able to get it checked out with an endoscopy if there's a problem? Eek. Do not want.
6. My understanding is that complication rates with the bypass are significantly greater, especially longterm due to malabsorption. While I will be taking vitamins for the rest of my life, chances are that I won't end up in the hospital if I stop because the sleeve has no malabsorption involved.
7. For the most part (and there are exceptions) the people I know with the sleeve look and seem healthier than the people I know with the bypass. That's nothing scientific though.. just a gut feeling.
8. The sleeve leaves you with a fully functional pyloric valve at the bottom of your stomach whereas the bypass gives you a stoma which can stretch over time.

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There you go. My reasons and rationale for the VSG in Ottawa over the RNY. Your situation is individual and must be treated as such. Research. Know your health history. Know the contraindications for the various surgeries. And talk to your doctors. Be your own health advocate. We all need to play an active part in our health and decisions pertaining to it. Speak up and be heard, but listen to the professionals. They know what they're talking about and have likely seen it all before. Rely on them for professional advice but know that you can go elsewhere if you need to. Be aware though... you might get the same advice from multiple professionals. If so, there's a good reason for that!

Take care all and good luck finding your own path.

I see a few people on the forums discussing whether or not to get a Medic Alert Bracelet for post-op.

There are lots of pros and cons regarding this. I find that Diminishing Dawn has outlined them perfectly in her blog post. Take a peek for yourself.

I decided not to get one. However your mileage may vary.

*In the event that Dawn moves her blog, I've copied and pasted the content below. All rights to this information belong to her and her alone.*

After surgery, it is quite common for the WLS community members to rush out and get a medic alert bracelet.  I was told that this was a must for any RNYer shortly after surgery. Even surgeons still recommend them. Many facilities are now staying NO to medic alerts - at least to putting a lot of information on them and rightly so.  Many facilities are finding that the messages written on them are now causing more problems with hospital treatment rather then helping.

I encourage you to really give the purchase of a medic alert bracelet some good thought.  Think about each thing you choose to put on it and what the benefits (and risks) could be.  Rather than go blindly by common statements that people will tell you to put on them, please consider all the aspects of what you put on the bracelet.  Today's post is going to take some of the common statements put on bracelets and explain why they can be a good and bad thing.  I've read this on various boards, talk to some medical personnel and heard some of the following information.  I admit I blindly went out and bought mine just based on what others told me to do.   Ultimately the decision is up to you, but I thought I would at least share what I've learned over the years that has changed my mind on the whole medic alert issue..  

Remember that medic alert bracelets are for times of unconciousness - when you cannot speak for yourself.  They are designed for FIRST RESPONDERS - paramedics.  Realistically, most of the time when we do go to the hospital - even those of us who had RNY and have complications come up, we are totally capable of speaking when we go in.  Those of us who do go in to the hospital often have caregivers that do the speaking for us.   A well educated colleague, spouse or family member will go much further than having a bracelet speak for us.

So here's the top message that typically RNYers put on their bracelets:

No blind NG tube
RNY Gastric bypass
my surgeons name
ICE phone #
no NSAIDS and no sugar  

So let me take the time to explain WHY these messages can cause more harm than good.   First of all, if you are going to get a bracelet be sure to put your surgery type and date on them.  Not simply "gastric bypass". It is called a Roux En Y.  (Not RYN as I see so often!).  Putting your surgeon and your surgery date might help although chances are he's not going to remember you much unless you are fresh out of surgery.  But it is never a bad thing if your surgeon talks to anyone and explains the surgery to them.  That's always a bonus.      

As for NG tubes:  They are inserted in patients immediately after major surgery to help keep the stomach empty and prevent postop vomiting and used to feed and administer meds in critically ill patients. In addition, nasogastric tubes are routinely used to collect gastric contents for lab analysis and to aspirate the gut in case of a GI bleed or a drug overdose. The chances of you needing a NG tube are pretty slim but it may be necessary. There's a myth that when put into you, the medical personnel will push and push the tube through and burst your pouch.  That is untrue.  Medical personnel are trained that when they feel resistance of any kind, they stop. 

The ICE information is always good - in case of emergency call.....

But here's the other thing I see put so many times on RNYer's bracelets that scares me - no aspirin or no NSAIDS. While it is true indeed that we should not be on them long term, there may come a time when I will gladly open my arms to aspirin!  If I were to have a heart attack, PLEASE PLEASE give me aspirin!!

Most heart attacks develop when a cholesterol-laden plaque in a coronary artery ruptures. Relatively small plaques, which produce only partial blockages, are the ones most likely to rupture. When they do, they attract platelets to their surface. Platelets are the tiny blood cells that trigger blood clotting. A clot, or thrombus, builds up on the ruptured plaque. As the clot grows, it blocks the artery. If the blockage is complete, it deprives a portion of the heart muscle of oxygen. As a result, muscle cells die — and it’s a heart attack. Aspirin helps by inhibiting platelets. Only a tiny amount is needed to inhibit all the platelets in the bloodstream; in fact, small amounts are better than high doses. But since the clot grows minute by minute, time is of the essence.

Since my own mother had a massive heart attack at age 59, I definitely will risk an ulcer in order to treat a heart attack!!  Remember, it's generally a long term use (2 weeks or more) that NSAIDS cause ulcers.

Here's another BIG issue that I want to bring up.  The no sugars statement really seems pretty harmless doesn't it? Not so. It could be dangerous.  It is a common side effect for many of us after our first or second year post op, to develop reactive hypoglycemia .  It's been quoted from 1/4 of us to 3/4 of us will get RH.  When you have RH, you bottom out in your sugars and get extremely low. Dangerously low. Guess what you need? Yep, sugars.   You need to raise your sugar up back to a healthy level.  It is much like people with diabetes having a low.  We can appear drunk, wobbly when moving around and having a low.  Like diabetics we can become unconsciousness.  If I were at the mall and someone noticed this and I started to pass out and they perhaps recognized the signs as being low sugar and were going to treat me, I'd hate for them to look at that bracelet and see "no sugars" and not treat me.   Is sugar going to kill me? No.  Could not getting sugar kill me? It potentially could.

The thing is that first responders aren't generally going to start giving you food and start feeding you sweet tarts.  They are not going to make a point of feeding you - that's what happens at the hospital and that's not til you are stable and they've figured out the medical problem.  That's when your family member would tell them about your restricted diet -- or quiet honestly, you will because you'll be conscious by the time the ordering menu comes around and you need to place a meal. No one is going to start feeding you sweet tarts, apple pie or hot fudge sundaes in an emergency situation.  

So give these aspects some thought before you decide what you'll put on your bracelet if you even decide to buy one.  Sometimes like they say, less is more.

Oh and do I wear my bracelet? No.  It sits in my jewellery box.

Dawn

This information was useful for me and I know I see other people struggling to modify their daily goals in My Fitness Pal. This is probably the most used food tracker for us WLS patients. That's what the consensus seems to be. The database is massive and you can add your own recipes and modify things as required.

In any case this is useful. I thought I'd post it here for others to refer to, if needs be.

___________________________________

On my profile, I elected to modify and track calories, carbs, fat, protein... as well as fiber and iron (two things I have trouble with, personally). I changed the recommended daily amounts and percentages, and while MFP still tells me on occasion that I'm not eating enough calories, I ignore that a$$vice. But it's such a useful tool to keep an eye on things on a daily basis.

To change your daily targets for protein, etc., do the following in MFP:

My Home --> Goals --> Change Goals (button) --> Custom (radio button)  and input your amounts there.

Additionally to see what items you wish to track on your Food home page, do this:

My Home --> Settings --> Diary Settings --> Select from the drop down fields up to five additional things you would like to track on your Food page.

I hope this helps you. It certainly helped me! Good luck!

My surgery was February 3, 2014. I had a VSG with Dr. Yelle and I had no complications. I was 43 years old with no co-morbidities but my BMI was 50 when I started the Opti.

My surgery was scheduled for 8 a.m. on that Monday morning. I went with my husband to the Ottawa Civic Hospital upstairs to the designated waiting area. I was there before they opened at 6 a.m. and there were a lot of folks coming for day surgery too. (It's 'day surgery' but we get admitted for a night or two while most of the others head home.) 

They put a hospital ID on my wrist, and another wristband indicating my allergies, and Hubby and I headed through a door to the back area where I was given a bed. They closed the curtain and I stripped down and put on the gown they gave me. We get a Bariatric or Bari Bed (wider and set up for people who are larger) and Hubby had a chair to sit in next to the bed. I got under the blankets and I was chilled; they gave me warm blankets.

I had a nurse come and talk to me there, verify the information on the computer next to the bed that was in my file, and they gave me a valium (or similar) type of medication so I could relax a little because I was so nervous about the IV. They had me put on booties on my feet, and a hair covering for my hair. I went to the bathroom for the last time and they took a moment to weigh me (at my request) so I could see how much I had lost on the Optifast (26 lbs in 3 weeks!). 

When it was time, Hubby kissed me good bye and a porter wheeled me off to the hallway just outside the OR. There, I saw my doctor, assisting surgeon, nurses, and I met the anaesthetist who would give me the IV. He'd read my chart and he promised he wouldn't do the IV until I was in the OR and settled. He was Scottish; lovely fellow. I do remember that. Funny as anything. 

They had me get down from the bed, and walk into the OR with a sheet over my back, covering the opening of the gown. I walked in and got up on the table myself, and they undid the back of the gown to give them access to my tummy when the time came. It was there that I chatted a bit more with the nurses, anaesthetist, surgeons, etc. They put in the IV, put a mask over my face and before I knew it, I was out. 

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I woke up in recovery; Hubby isn't allowed back there. He tells me that he left the hospital and came home. My surgery was for 8 a.m. and they called him at 8:56 a.m. to say that everything was good, and I was on the way to being awake and I was in recovery. He had to call back around noon to get my room information. He called at 12:15 and they told him that I still didn't have a room, but he went to the hospital anyway and by the time he got there, I was in a room.

They had wheeled me from recovery up to my room, and I got down off the bed (with assistance!) and walked to the bed in my assigned room and got comfortable with their help. The nurse introduced herself (Bea was spectacular!) and wrote all sorts of pertinent info on the whiteboard at the foot of my bed.

The bari patients are only two per room. There is no other option. Two beds per room and two rooms for WLS patients at the Ottawa Civic. The rooms are located in the Trauma (aka Secure) unit. You have to ring to get inside and the nurses can push a button to open the doors. Hubby saw me early that afternoon and stayed for an hour or two before leaving for home again. That evening, he came back with our 4-year old daughter and by the evening, I was drinking apple juice mixed with water and a bit of chicken broth. The two other ladies who had surgery that day weren't up to drinking much yet, but they did manage some juice by the evening hours.

It was SUPER quiet because we are in the Trauma unit. I didn't need ear plugs. It was very good. But to each his/her own. Bring them if you wish and know you may not need them. Rules regarding visitors: It's a secure area. As long as you have only one visitor, he/she can stay later than the 8 p.m. curfew. Especially your spouse; that's not a problem.

Hubby came back the next day and helped me take a shower. There's a toilet and sink in your room (for the patients only) and a shower in another room across the hall in the Trauma unit with loads of space in the shower room to have someone assist  you to wash up. I changed into my own pyjamas after the shower and was immediately more comfortable. Many patients are concerned with having a catheter or drains. I did not have either of those. I was able to go to the bathroom a few hours after I got in my room, and as per standard, the nurses measure your urine output to ensure you are not dehydrated. I did, however, have an IV which was removed right before I took my shower, the day after my surgery.

I walked the halls in the Trauma unit by myself back and forth, and when Hubby was there, I walked down to the cafeteria with him to get out and stretch my legs a bit. That felt really good. I had my iPhone and my iPad with me and a charger with a long cord; it's a secure unit and I had no trouble leaving them there (hidden from view) while I walked around. There is a narrow cupboard as well with space for a carry-on type suitcase and clothing/coats.

Without complications, I stayed for two nights in the hospital and was discharged around 11 a.m. on Wednesday, February 5, 2014.

I hope this all helps you. I know how nerve wracking it all can be. But hang in there. You can get through it. So many of us do and you will do great! By all means, if you have any other questions, do get in touch. I'll only be too glad to help you and try to answer anything that might be nagging at you. 

A PATTS is an appointment at your hospital for pre-admission testing and filling out necessary forms and the like.

I went through Ottawa's Weight Management Clinic at the Civic Hospital. My PATTS was held on January 27, 2014. Surgery was one week later on February 3, 2014. Some people have their PATTS one month before surgery. Others have theirs only a day or two before surgery.  

I see many posts about "What Happens at a PATTS appointment?" Here is what happened at my particular appointment. Your experiences may vary, of course!

My appointment was about two hours in length. They started by having me go to admitting on the main floor of the Civic Hospital with my insurance information, etc. Just an FYI, if you are married, bring your spouse's information as well and they can take that too, if you are covered under anyone else's plan.

After I was done at admitting, I took the elevators upstairs. There, after a 5-10 minute wait, I went into a consultation room and I met with the following people:

• a gentleman who recorded all of my current medications into my electronic file. They want to be sure they have everything correct; I suggest bringing your medications with you so they can get the information easily. Less detail for you to have to remember too!
• an anaesthetist. He and I spoke at length because of the fears I have about needles and IVs. He was very reassuring. He wanted to check my teeth, had me open my mouth wide, etc., to see if I had dental work he needed to be careful with, and that sort of thing. He was great.
• a nurse. She went through the booklets that they had given me about what would happen on the day of my surgery, etc. She answered all the questions I had.
• While I spoke with the first nurse, another nurse came in to do an ECG. Just a quick check of heart rates and patterns to make sure they had current information. It took less than two minutes and it's easily done on the bed in the room you will be in. Just a matter of lying down and they hook up the nodes for a 1 minute recording. And blammo. She was finished.
• a phlebotomist who took blood work so they had current values on file. That was difficult for me (needed a few sticks, lying down, etc.... remember the fear I have of needles?!) and that was done and I was outta there.

Two hours in total. Not too bad all in all. And I was ready for surgery one week later.

I hope your PATTS goes super smoothly and you too are prepared for your upcoming surgery!

I had my VSG on February 3, 2014.

I see many posts asking "What do I need to bring to the hospital?"

Here's what I brought with me.

• robe and slippers for walking the halls -- bring slip on shoes/slippers for your feet and a robe if you wish
• toiletries -- lip balm, toothbrush & toothpaste, my OWN facecloth (ick, I'd NEVER use the ones in the hospital on my face!), shampoo, body wash, deodorant (I showered the day after surgery)
• comfortable pyjamas -- after my shower I didn't want to put on yet another hospital gown
• iPhone and iPad and charger -- entertainment was a godsend! 
• my own pillow -- I used it in the hospital as well as for the ride home to hold against my tummy for protection when going over bumps! 
• medications not related to the surgery or weight loss that I was taking and were required

I know many people advocate taking ear plugs as well. Ladies, take pads if you expect your period while there as well.

And make sure the clothes you wear to the hospital are loose/comfortable enough to wear HOME from the hospital.