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My Journal
June 13, 2006 update:
Wow, how time flies! Actually,
I haven't been able to make changes to this site over the last
year ... something to do with a file permission issue.
Imagine that - one day I wake up and
I no longer had permission to update web-related files on my own
PC!
Today isn't a rainy day (it's a
blistering 32°C) but I thought this was as good a time as any to
try and resolve my technical woes.
If you're reading this, then I
was successful.
May 17, 2006 update:
Today I spoke with the two Canadians
I accompanied to Michigan last month for their consultations with
my DS surgeon. They both had their DS
surgery last week performed by the
magnificent Dr.
Marek Lutrzykowski
and are recovering nicely!
I am now 28 pounds away from my
weight loss goal!
May 16, 2006 update:
Today I was contacted via email by a
journalist from the Ottawa Citizen. She asked if I'd be interested
in being interviewed for an article she's doing regarding a report
prepared by the Ontario Health Technology Advisory Committee --
the report was commissioned by the Ontario government -- that is recommending
weight loss surgery for morbid obesity be expanded in Ontario to
treat patients here in Ontario instead of sending them to the U.S.
at a significantly higher 'cost'.
The report calls for the
establishment of 'bariatric centres of excellence' in
Ontario and suggests increasing the number of weight loss
surgeries (WLS) from 200 to 1,250 yearly.
Last year while 200 WLS procedures were performed in Ontario, 600
individuals who meet the stringent criteria for out of country
funding set by the Ontario Ministry of Health - Long Term Care, were
shipped off to the U.S. By the way, although each of the 600
had their surgery cost and short hospital stay covered, their travel
expenses, 10 day hotel accommodation, along with other
out of pocket expenses remain the responsibility of the patient.
While there are a few dozen Ontario
surgeons trained to perform weight loss surgery, hospital budgets
prevent these surgeons from accessing the surgery time to treat
the overwhelming number of morbidly obese Ontarians seeking to
have weight loss surgery here in their home province. The result is
that these surgeons have 6 to 8 year waiting lists, and some
won't even accept new additions to their wait lists.
One bariatric surgeon in south
western Ontario operates a lottery system, first ones in
the gate with an application every August, may be fortunate to
have the surgery performed by him in Ontario with a maximum of a
year wait. But don't consider applying if you're over 40 or if you
have an extremely high BMI (Body Mass Index) because he only
operates on younger morbidly obese patients under a certain BMI
who present less of a surgical risk!
It'll be interesting to access a copy
of the report to discover what specific procedure or procedures
would be performed at the proposed 'bariatric centres of
excellence'. I am so happy I had my DS surgery performed by the
wonderful
Dr. Lutrzykowski in Michigan before any of the proposed
changes to Ontario MOH-LTC protocols which may severely
restrict access to out of country surgery.
May 2, 2006 update:
There's an interesting article
circulating among the listservs today regarding findings from a
New York-Presbyterian/Weill Cornell Study which suggests that the
Duodenal Switch may be more effective than the Gastric bypass.
Duodenal Switch Patients Lose More Pounds and Fat
Excerpt:
NEW YORK (October 14, 2005) — The
most frequently performed weight-loss surgery, the gastric bypass,
may not be the most effective in producing weight loss, according
to a preliminary study by physician-scientists at New York-Presbyterian
Hospital/Weill Cornell Medical Center.
The study finds that a more complex procedure, the duodenal
switch, was more effective at promoting loss of body weight and
body fat than gastric bypass.
The study followed 13 patients who underwent duodenal switch and
33 patients who underwent gastric bypass, all with comparable
pre-surgery body mass index (BMI) and body composition. One to two
years after surgery, duodenal-switch patients lost 50 percent more
weight than gastric-bypass patients (22.3 BMI units lost vs. 15.1
BMI units lost). Furthermore, duodenal-switch patients reduced
their body fat to 25.7 percent, compared to 34.0 percent for
gastric bypass patients (25 percent body fat is within the normal
range for most people). These findings will be presented at the
2005 North American Association for the Study of Obesity (NAASO)
meeting in Vancouver on October 16.
Read the full article at this link
April 28, 2006 update:
Given the volume of Canadians from
Ontario who have found this website and emailed me with questions
or requests for help with the Prior-Approval for Out of Country
coverage process, I have created this new page which makes
available template documents to assist individuals with the
process.
Follow this link: Prior-Approval for OOC
coverage
April 25, 2006 update:
It's now
been 8 months since my surgery and I am 38 lbs away from my goal
weight. I have no regrets!
Over the
last 6 months, I've assisted 12 Canadians to get out of country (OOC)
approval and literally walked each one of them through the
application process. It's been extremely rewarding to watch
11 of these 12 people flourish and enjoy their new life!
Well the 8th person I helped, never bothered to contact me after
her surgery but I hear she's doing well.
Two weeks
ago, I accompanied two more Canadians to Michigan for their
consultations with Dr. Lutrzykowski after walking each of them
through the OOC application process. They now have surgery
dates booked for May 10th and May 11th respectively. I am so
excited for them! I'd never met either previous to having
received an email from each of them inquiring about the DS.
Isn't this a fantastic tool?
What I've
discovered through this process of helping other has been that I
get as much out of it as the individuals I assist. It helps
to renew my excitement about the habit-forming life style changes
and also in the healthy choices I make 99% of the time, when I
share with others.
While I still offer information and
assistance with those struggling with the OOC application, after
exchanging 62 emails in one day alone with a very anxious
individual contemplating weight loss surgery, I now am not
as available to respond to every question about vitamins, pre-op
and post-op related questions, food questions, etc because there
are more appropriate forums where answers to such questions can be
obtained (see the Support page for
links to some of these forums) and where responses to these repeat
questions can benefit more than just the individual asking via
email.
So please first check through the DS forum -- if you don't find
your question answered there, post your question in that forum.
There are hundreds of individuals registered in the DS forum from
all over the world, eager to assist and respond to questions from
newcomers.
February 28, 2006 update:
It's been 6 months since I returned
home after my WLS in the U.S.A. I've lost over half my desired
weight loss goal. Has it been easy? Yes and No.
Mostly, I'm just glad to be alive with another chance to make life
better for me, and also for my family.
There have been so many spin off
benefits to having had this surgery and it's not all about weight
loss. For me, the time out these past 6 months has been
invaluable. Prior to having the surgery, I spent almost
every waking hour, engaged in online activism. So in would
be a huge understatement to say that I experienced a significant
paradigm shift during my sabbatical from my avocational pursuits.
This journey has been invaluable to
me in so many ways. I've learned a great deal about myself
in the process and continue to learn on a daily basis. I'm
grateful for the opportunity to reclaim my life and appreciate the
life around me rather than continually trying to change the world.
I've learned that change must start right here, with me. How
profound :-)
One of the most satisfying aspects of
my post surgery time has been helping other Canadians considering
weight loss surgery in the U.S.A. with information, support, and
completing the required paperwork to gain approval from the
Ministry of Health for out of country coverage.
July 27, 2005 update:
My surgeon's office has scheduled my
surgery for August 17th at 11:30 am. There's a snag in that my surgeon
wants to attend while gastroenterologist conducts a
panendoscopy on me either 2 days or the day prior
to surgery. This is why this scope needs to be done in the USA
rather than in Canada.
July 19, 2005 update:
Today I was diagnosed with
hypothyroidism based on some lab work I had done on
Friday as part of the pre-op tests ordered by my US surgeon.
My GP has prescribed a low dosage of a thyroid hormone called
Eltroxin to regulate my thyroid. What a kicker that
it took a US surgeon to order the appropriate test - a
TSH - to finally discover I have a thyroid condition that
is responsible for the classic symptoms I have been experiencing
since my weight gain started a few years ago.
Symptoms
of Hypothyroidism:
-
Fatigue
-
Weakness
-
Weight gain
or increased difficulty losing weight
-
Coarse, dry
hair
-
Dry, rough
pale skin
-
Hair loss
-
Cold
intolerance (can't tolerate the cold like those around you)
-
Muscle
cramps and frequent muscle aches
-
Constipation
-
Depression
-
Irritability
-
Memory loss
-
Abnormal
menstrual cycles
-
Decreased
libido
After doing
some research online, I opted not to commence the
Eltroxin at this
time as this would preclude a
Thyroid Scan and Radioactive Iodine Uptake (RAIU) for 6 weeks.
Instead, I called my doctor's office to request authorization and
a requisition order for a thyroid scan and uptake. She's
agreed to do so and I am now waiting for a test date. My
doctor shocked me at my last appointment, stating that in view of
fact I now have this diagnosis, she would prefer that I not have
this surgery as I will have much more success losing weight once
my thyroid is regulated. While I know that my doctor cares
for my health and well being, I am disappointed at how she chose
to communicate her "opinion".
I doubt I
want to be vocal about my under-active thyroid to my friends and
acquaintances as the usual response to any claim by an obese
person that their weight issues are due to a "thyroid condition"
is one of disbelief and ridicule.
July 5 - 9, 2005 update:
Had a great
time with my friends Pamela and Leslie in London. I
travelled to Michigan with Pamela to go to Barix Centres in
Ypsilanti for her pre-op testing on July 6th and then for a
consult with Dr. Lutrzykowski on July 7th. He would
like me to lose an additional 10-15 pounds prior to surgery (to
shrink the fat around the liver) and return two days prior to
surgery date for another consult to discuss risks and
complications and one day prior to surgery to have a
panendoscopy to be performed by he and his
gastroenterologist.
May 29, 2005 update:
One of the benefits of this lengthy process (to obtain prior
approval for out of country coverage for bariatric surgery) is
that while waiting, one has an opportunity to continue
researching! And mine has paid off. I have, after much
consideration, decided against having the Roux-en-Y Gastric Bypass
(RNY-GB) in favour of having the Duodenal Switch (DS). The DS
procedure best matches my needs/expectations in terms my weight
loss goals, short & long-term risk tolerance, and side-effect
tolerance.
My consult with Dr. Lutz is booked for July 7th, 2005!
The determining factor in choosing this surgeon were comments I
read on the profile page of Dana Wenzel of Chesterfield MI, who
had the DS procedure done by Dr. Lutz in 2004. What an outstanding
endorsement Dana provided! Additionally, I was blessed to connect
with two other Canadians, David B and Wendy B, who with much
patience and generousity, shared relevant information. And what
finally sold me were two virtual friends, Shelia and Renae in
Michigan!
_______________________________________________________________
In preparation for surgery, I quit smoking (cold turkey) on April
27, 2005. YAHOO!
_______________________________________________________________
BACKGROUNDER
20 years ago, in 1985, my weight ballooned up to 264 lbs, with 110
lbs of that weight gained over the 6 previous years living in a
university residence. I accumulated the weight through these
factors:
* no exercise … other than walking between classes & residence,
* sleep deprivation … studied to 3AM each night to maintain GPA &
scholarships,
* poor eating habits (i.e. skipped breakfast & lunch, late night
eating),
* no mother around to monitor & regulate my diet & exercise
regime,
* drank excessive amounts of caffeine (espresso).
So here I was, fresh out of university armed with 2 degrees, and
no life outside my work. It was easy to fast track up the
corporate ladder ... With much success in the workplace, I came to
define myself by my WORK. I knew that something was missing but I
was so driven to succeed and be at the top of my game, I didn’t
give much thought to building a life outside my work.
Then in late 1984, an appointment with my hair stylist changed my
life. My hair stylist, CJ, had lost over 100 pounds from weight
loss surgery. She encouraged me to contact her bariatric surgeon
and inquire if I was a good candidate for weight loss surgery.
In the
spring of 1985, I had weight loss surgery during my vacation -- a
standard Mason VBG (vertical banded gastroplasty) partitioned and
undivided. I went from a weight of 264 lbs to 143 lbs -- a loss of
121 lbs over 18 months.
I maintained that weight loss for 11 years by sticking to the
strategies I knew would ensure success. The most I allowed my
weight to fluctuate was a couple of pounds.
Three years post surgery, in August 1988 I got married, modeled my
wedding gown (an Aldo Beltrami original design from Italy) in
Wedding Bells Magazine (Summer 1988 issue), and within 2 months I
was pregnant with my first child. I gained less than 14 lbs
through the pregnancy and delivered a small but healthy baby boy
on July 4, 1989 weighing 5.5 lbs.
During my pregnancy, and after Free Trade, my company was taken
over by Americans (General Signal Corp). So when my pregnancy
leave was over, I opted not to return to work or Toronto. Instead
I remained in northern Ontario – about 200 miles from anywhere.
One of the unfortunate impacts was that I no longer had easy
access to my surgeon to continue the yearly follow up
appointments.
Sadly, as it turned out, my phenomenal surgeon, Dr. MD was facing
allegations of sexual misconduct brought forward by some former
patients … much to my amazement my hair stylist -- the woman who
referred me to her surgeon, was alleging that she was one of his
victims. She contacted me several times asking me if he had ever
acted inappropriately with me. The answer was NO I repeatedly told
her, to which she kept asking me “are you sure?” as though if she
asked enough times, I might respond differently. (Isn't that the
definition of insane... repeating a behaviour and expecting a
different result?)
I found my surgeon (Dr. MD) to be very professional at all times
and I had, and continue to have, a profound respect and admiration
for this highly skilled surgeon, one of Canada’s pioneers in
bariatric surgery. The College of Physicians and Surgeons revoked
Dr. MD's registration in 1997. I found that news incredibly
depressing.
I will never believe that what happened with Dr. MD and his
alleged 'victim' was anything but consensual and I am a feminist!
I base my belief on my personal knowledge of the morally and
financially bankrupt hairstylist who had no ethics -- the woman
was a con artist and habitually ripped off the system and everyone
she came into contact with.
____________________________________________________________
1996 - ELEVEN YEARS
POST-OP
10 years post surgery, my partner fell three stories off a roof
and didn't break any bones nor did he appear to sustain any
permanent damage. At around the same time he was complaining of
chronic pain in his side which his doctor attributed to the fall.
I believe that coming so close to his mortality prompted my
partner to insist on having another baby and he needed my help in
that process although I was reluctant and intimidated by the
prospect of another child. In the end, although not thrilled with
the idea, I knew it would be good for our other son to have a
sibling.
Then in 1999, 3 years after our second child was born, my partner
discovered he had HCV and cirrhosis of the liver. And within a few
weeks, my beautiful 3 year old son was diagnosed with autism
spectrum disorder (he's high functioning and is in a mainstream
classroom with minimal accommodation.)
So that was the setting that I suddenly found myself in. Perhaps
it was the old Catholic guilt for being healthy and well while my
partner and son were not, that made me embrace the opportunity to
become "martyr, caretaker and saviour" (now there's a Trinity of
losers!) ... Perhaps I also used this to rationalize the fact I
was about to drop all the strategies and changes in behaviour I
had in place that were responsible for the maintenance of my
weight loss.
Or perhaps I was just itching to find ANY excuse whatsoever to
relinquish ownership, responsibility or accountability for my
behaviour while acting the role of St. Barbara.
Those were miserable and lonely times for me and I think I knew
that food could provide some instant gratification without the
kind of damage that drugs could cause ... And since I could never
stand the taste of booze and would never do drugs, all that was
left was food to indulge in since extramarital sex is never an
option when you've been raised in an Italian, Catholic family and
you marry another Italian ... not unless you want to end up at the
bottom of Lake Nipissing.
It's pretty sad to realize now how little I valued myself in those
days that I truly felt guilty for my good health. My partner
started a clinical trial on a new type of interferon combo and
would sleep around the clock. His working and earning days were
clearly over.
So I made some big changes in my life in 1999 ... I started taking
on LOTS of contract work that would permit me to work from home.
And I used the excuse that I could better manage my household and
the needs of my family members including the disabled partner
unable to work, and a child with autism spectrum disorder who had
no access to early interventions because of immensely long waiting
lists.
It doesn't take a psychic to foresee where this would lead... ***
Workaholics should never work out of their home. *** I buried
myself in my work and hated to stop even to go pee let alone eat
throughout the day. Imagine! Perhaps it was because it was the
only thing other than my youngest son that gave me any
satisfaction! I was good at my work and it helped redefine me.
Since 1999, my partner has undergone 3 treatment protocols on
alpha-b interferon and pegylated interferon. The first time it was
for 6 months. The second protocol again lasted 6 months. And the
third protocol lasted for 11 months (48 weeks) at double the
dosage of previous protocols. He pretty much slept 18 hours a day
for the last 6 years. And while he slept and got better, I worked
and worked and my state of health and wellness diminished greatly.
I have gained and I have lost a significant amount of weight, a
total of 5 times over that period. It must have really freaked him
out to watch the little woman he married turn into a big,
unhealthy blob. How very sad that my partner inferred my
reluctance to be intimate as a fear of contracting HCV rather than
as my shame and discomfort with my weight.
He was thrilled recently when Roche Canada, the pharmaceutical
company that produces the interferon that cured him of HCV and
saved his life, invited him to speak to their Pegasys team. He's
proud of his accomplishment and well he should be. Only three
people completed the protocol and my partner was one of them. I
swear he is the most disciplined person I know and I wouldn’t
doubt he could walk on water if he set his mind to it.
Back to me -- I am responsible for abandoning my needs and placing
myself last. I am not trying to make excuses as I take complete
responsibility for the poor choices and decisions I've made ...
just want to clarify or rather lay the ground work for --->
How I fell into the same old patterns/habits I did during my years
in university (residence) which resulted in huge weight gain:
* working around the clock,
* extreme sleep deprivation,
* poor eating habits (no meals in day, eating late in evening),
* drinking triple espresso's all day/night long,
* snacking/grazing late into the night,
* not taking vitamins and supplements, and
* no exercise! (heck if I wasn't having sex, I wasn't going to
make time for exercise)
Therefore, it comes as NO surprise to me that I now find myself
morbidly obese for the second time in my life after several years
of ignoring the successful habits that afforded me the privilege
of maintaining my weight loss for 11 years.
I screwed up in a major way TWICE but now I clearly understand WHY
and HOW and hope that I can share this with others so they do not
repeat my stupid mistakes. The WHY doesn't matter as much as the
HOW. We face the "why" crap on a daily basis that can bring us
down if we let it. If we're looking for excuses to justify
whatever it is we want to do, there will always be readily
available excuses.
When I had my surgery 20 years ago, there wasn’t the level of
public education/awareness, access to information, and/or
knowledge sharing that is available today via technology … not to
mention the availability of online SUPPORT forums like the
Duodenal Switch forum, AMOS, ObesityHelp, and the OSSG groups in Canada, which are quite
simply, INVALUABLE!
The very first thing I am going to do when I rejoin the corporate
jungle and am again earning bug bucks is to donate a healthy chunk
of money to help keep ObesityHelp in operation!
I am happy that the world has changed a lot in 20 years and I urge
anyone going through WLS now to:
* get informed (don't just follow the herd)
* find support
* commit to lifelong process of successful and proven strategies
to maintain weight loss which requires a lifelong CHANGE in
BAHAVIOUR, through good times and through hard times.
I had actually shared this with Mike in NY about to have WLS on
May 26/05. I thought it might be worthwhile to amend the text to
use in my profile... whether you read it or not is not an issue
for me ... this is a cathartic experience for me and has helped to
clarify for me how I ended up back to where I started 20 years
ago.
__________________________________________________
MOVING FORWARD
I am waiting for OHIP approval to go to the USA for surgery. I’ve
resolved that I am proceeding with this either with or without
OHIP’s help and if they don’t help me, when I return to Canada
after my WLS I will make it my life’s mission to launch a legal
challenge of the denial to fund my request for out of country
medical considering the wait time for surgery in Canada is from 6
- 8 years.
The prospect of going to the USA for WLS scares the stuff right
out of me ... But I've decided to focus on moving forward with my
life and think of what is best for me. I can't function as a
morbidly obese person and certainly would not live and would
continue to suffer irreversible tissue damage if I had to wait on
the Ontario waiting list for 8 years.
All I need is a qualified and skilled surgeon to get me through
the surgery and I will work the strategies for successful weight
loss maintenance with the same level of passion, energy and
commitment that I use in other areas of my life -- to ensure
permanent weight loss.
I better sign off before this turns into the book you never wanted
to read ;-)
Take what you like and ditch the rest.
Barbara .
STRATEGIES FOR LONG TERM SUCCESS
1. Eating
* Eat three well-balanced meals and snacks maximum twice daily.
Daily servings for each of the food groups include:
* three servings of protein,
* three servings of vegetables,
* one serving of fruit,
* two servings of bread/starches, and
2. Drinking
* drink water - 40-64 oz of water per day,
* do NOT drink carbonated beverages including sugar-free
carbonated beverages,
* do not drink sweetened juices or beverages,
* reduce consumption to 12 times a year or eliminate caffeinated
beverages,
* reduce consumption to 12 times a year or eliminate alcoholic
beverages.
Why Carbonated drinks are an issue:
- when a cold beverage is consumed, it warms and releases gases,
distending the stomach... stretching of the stomach then creates
undue stress
- carbonated drinks are high in calories, low in nutritional
value, and contain simple sugars ...they're absorbed quickly into
blood stream, causing rapid rise in blood sugar, elevated insulin
levels, & increased hunger.
- carbonated drinks contain caffeine which acts as an appetite
stimulant
- eliminate diet sodas
3. Vitamins and Supplements
* take daily a daily multiple vitamin, supplemental calcium
citrate, & take supplemental iron such as Trinsicon or Chromagen
and whatever else your doctor advises.
4. Exercising
* exercise regularly to maintain weight... recommend an average of
four times per week for at least 40 min.
5. Sleeping
* sleep 7 hours per night
6. Take Ownership for Staying in Control
* weigh yourself weekly - by weighing weekly and allowing yourself
only a few pounds / kilograms of leeway, you can maintain control.
I regained all my weight following 11 years of maintaining my
weight loss because I stopped taking ownership for staying in
control.
I blamed my circumstances that resulted in the following BAD
habits -- no exercise, poorly balanced meals, constant grazing and
snacking, drinking excessive amounts of caffeine and carbonated
diet drinks.
These bad habits resulted in me gaining 100 pounds over 6 years --
twice in my life.
CONCLUSION:
Changes in old behaviour and forming new, lifelong habits are
required for SUCCESSFUL weight loss and MAINTENANCE!
To be successful after WLS, you must:
• eat 3 well-balanced meals & maximum of 2 snacks daily,
• drink a minimum of 64oz of water & avoid carbonated beverages of any kind,
• take your multiple vitamins & calcium citrate regularly,
• sleep at least 7 hours per night,
• regular exercise is imperative,
• weight control is YOUR own personal responsibility.
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