OHIP qualification & referal

Question
QUESTION: Hi Dawn,

I think I meet OHIP's requirements for bariatric surgery and I think that a surgeon would choose a RNY operation for me.  I am 37, female (never, ever wanted children), 5' 6" tall, 314 lbs, BMI of 50.1, and have normal preliminary bloodwork, but have been depressed since I was 12.  

I have been seeing two psychiatrists: one, a psychoanalyst for about 7 years 4 times a day, and the other, a specialist in treating difficult cases of mental illness with drugs for about 15 years.  The latter doctor actually recommended surgery and sent me off to my family doctor.  Both psychiatrists are going to write letters for the surgeons that despite my mental health history, I am "mentally stable" and able to withstand the pre-op tests and liquid fasting and the post-op liquid fast and all the life style changes that would come with a RNY operation.

I am heartened to have received an appointment with the head of the Bariatric surgery centre for my postal code, but I am wondering whether this is unusual.  I just went to my family doctor 5 weeks ago, and I have an appointment with this head of the surgery division at the hospital in about a month's time.  Does this mean that my family MD went through the registry and I'm just lucky to see the head/director so quickly?  My family MD ordered that a copy of my bloodwork be sent to the head/director and he faxed it back to my family MD that I was borderline low on Vitamin B-12, I presume he knows why I'll be seeing him. I have received no information package in the mail, just an appointment.  I thought the government sent you an info package before you got to see anyone.

I guess I worry that the surgeon(s) won't accept me and won't preform the operation.  

I assume I would be given a RNY because of the amount of weight I should lose 170+ lbs.  I would like to be 140 lbs, but I don't know if that's a realistic goal, even with a lot of exercise after the operation.  Currently, I have plantar faciitis, which makes it very hard to walk or even swim, and something wrong with my ulnar nerves in my lower arms which make it impossible to pick up or carry much, and back pain, so I've been unable to exercise.  But, I feel my feet and back would improve as I lost weight and I have many exciting plans of things I could do once I lost part of the weight, e.g. gardening, long-distance swimming, aquafit classes, SCUBA diving, and my dream of joining a no-skills non-contact hockey league in Toronto.

Thank you for your time, I appreciate any thoughts you might have!

Jennifer

ANSWER: Hello Jennifer

You definitely have extenuating circumstances which would make you possibly go through more hoops with the bariatric centres. They will definitely want those clearances that you mentioned.   

Which centre are you going to?

Normal procedure for most centres is going to an orientation of some kind.  Then you go through all the hoops of meeting a bariatric nurse, endo, dietican, social worker and so forth, then last you meet the surgeon typically.  Humber River is an exception to the program as you meet the surgeon first, then do all the appointments and then meet the surgeon at the end again. Is it humber that you are going to?

I'm a bit confused - is it the head surgeon that you are meeting or head of the program in terms of paperwork, like a manager of the centre.  I'm assuming surgeon and Humber but I could be wrong. If it is a "head" person who is in charge of the program, then it could be an issue where they want to let you know specific requirements that you are to go through.  I'm just unclear  who this "head/director" is.

Not all centres send out any kind of package. There is no package from the government or OHIP.  It's specifically what your centre gives out and some are more thorough with information than others.  My husband just got an orientation date - no package at all...so not all centres send out information.  Some centres have beautiful books that you can download, some give a few handouts. It's very centre-orientated unfortunately.  

140 lbs could happen. Likely? Not according to the surgical centre. They are looking for more like a 60%-80% of excess weight lost. Some people do better, some don't do as well. It really depends on the person and how well they follow the program.  RNY does seem like a good choice but it never hurts to read up on all surgery types. It is best to think twice and cut once.  If you need medications for your conditions though, you may look into a VSG and a DS. (DS is much harder to get though).  

This is a GREAT forum you will enjoy if you are computer savvy. I hightly recommend going there as it is loaded with people from all surgical centres in Ontario:

www.obesityhelp.com/forums/ON

On occasion, some people can be a little opinionated but for the most part, people are very caring, supportive and kind and will answer all of your questions there too! :) Of course, I would be more than willing to answer your questions at any time but again, you'll find more people dealing with YOUR surgical centre there and that's an awesome thing.

Nice to meet you Jennifer :)

Dawn



---------- FOLLOW-UP ----------

QUESTION: Hi Dawn,

Thanks for writing back so swiftly!  I feel I need all the encouragement I can get and I'm frankly afraid of meeting Dr. Stephen Glazer, the "Medical Director of the Bariatric Program at the Humber Finch site".  I don't know if he operates or not.

Is this man the surgeon who might operate and who will tell me if I will be tested and then approved for a operation?

I am considering the vertical sleeve as well as the RNY, but am going to leave the decision to the doctors, although the vertical sleeve might be a little better in allowing me to absorb my meds.  I don't know what you mean by DS though - could you explain?

Thank you,

Jennifer.

Answer
Dr glazer is an internist. He is the doctor who most goes over your case history.   He would follow you on the floor
After surgery, is in charge of medications etc.  He is a doctor of Internal Medicine.
So he will be the one to check for all tests and clearances you need.  He will probably review
Everything with you and then talk about any psyche clearances you need for the
Program to accept you.

Although it may scare you, they do want to you to succeed and are trying to set you up
For success so  try to go in there quite positively.   Some people go in acting very defensively
From the start.   That's definitely not in yourbest interest.  Just say you'll do whatever they need you
TO set yourself for success.  :-).  Please let me know how it goes :-)

Dr glazer should address both your mind and spirit whereas the surgeon will look from a medical viewpoint.

The duodenal switch is another operation - much more complicated surgically and nutritionally.

You really owe it to yourself to read about all surgery types and make your own decision.  You would be pushed automatically
To an rny, but you will be the one livIng the life so you should not let anyone make that decision for you. Research is important
No regrets!

Here's my email should you desire to drop me a line

[email protected].  

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