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Long Wait In Canada for WLS

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Old 10-27-2002, 05:58 PM   #1
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From our local paper - might be of interest and will, at least, make you happy not to be in Canada!

Obese face deadly wait for surgery
'Not many feel sorry' for morbidly overweight people, doctor complains

Sharon Kirkey
The Ottawa Citizen
Sunday, October 27, 2002

Jean-Pierre Groulx weighs 420 pounds and says his doctor told him that surgery is the only way to reduce his weight. He has waited a year for the stomach stapling.

About 100 dangerously obese Ottawa patients will have to wait up to three years for "stomach stapling" surgery, as a huge increase in demand combined with cuts to obesity surgery programs in Ontario have conspired to create one of the worst surgical waiting lists in the province.

And as many as 1,000 more people are in line for a consultation that would allow them to get onto a waiting list.

For "morbidly obese" patients like Jean-Pierre Groulx, this surgery is their only hope for a normal, active life, and possibly for survival itself.

Yet the lack of services in Ottawa, combined with cuts in London is causing new delays in their treatment.

Mr. Groulx, 57, weighs 407 pounds. Walking up three steps leaves him breathless.

When he leans back in his chair, his massive middle strains against 66-inch waist trousers.

Eight years ago, he was diagnosed with diabetes. In February, he developed acute congestive heart failure.

He has dangerously poor circulation in his legs; the skin is swollen and dry, with reddish-purple mottled patches where the blood vessels have broken. Sometimes the skin cracks and ulcers form, "which is very dangerous."

Mr. Groulx estimates he has lost, and regained, at least 500 pounds over the past 30 years. Ever since he was a child, he has always felt hungry, no matter how much he eats. By university, he weighed 260 pounds and the weight just kept climbing. "I've had so many people say you stopped smoking 18 years ago, you can do this," says Mr. Groulx. "With food it's different. When you stop smoking you aren't forced to sit down three times a day and have a cigarette."

In fact, nothing has worked. Not liquid diets or behaviour modification or hiding chocolates in the furnace room.

On Nov. 13, Mr. Groulx will be wheeled into a specially-equipped Toronto operating room where his upper stomach will be stapled to create a small pouch with an opening "about the size of a pencil," so that he will feel full after eating just a few tablespoons of food, instead of a few platefuls.

Mr. Groulx, who couldn't get the operation in Ottawa, says the aggressive procedure is the only chance he has. "My heart doctor told me, 'Jean-Pierre, without this, I don't know if you'll still be here in three years.' "

He has waited a year for his stomach-stapling operation.

Yet now the waiting list is stretching much farther, possibly to three years. Only one surgeon in Ottawa performs bariatric operations, and even then on only a handful of patients each year. The vast majority of patients must be sent to Toronto or London. But now the London obesity surgery program is being phased out because of provincial funding constraints.

"There has to be some kind of major overhaul of this whole situation," says Dr. Jacob Joffe, a general and bariatric surgeon at Scarborough Hospital, one of only the few obesity surgeons in Ontario whose waiting list now stretches to three years and who sees so many Ottawa patients he has regularly scheduled "Ottawa patients" days.

He says surgeons need more operating room time and improved remuneration for the technically demanding procedure in order to convince more doctors to start offering it.

"This is expensive surgery and there hasn't been a great deal of public acceptance towards it. The obese patient is still seen as lazy and non-motivated, and that it's somehow their fault that they are obese. Not very many people feel sorry for these people," he says.

"If you look around the Ottawa medical community you're probably going to find a lot of people who don't believe in (obesity surgery) out of sheer ignorance. Even the surgical community will say, no, we don't really want to do this. We need somebody to stand up and say, 'There's a problem here and this has to be addressed.' Would you wait three years for an operation?"

The growing demand reflects the nation's growing obesity crisis: 29 per cent of Canadians aged 20 to 64 are now overweight. Twelve per cent of all Canadians in the same age group are obese. Canada spends an estimated $1.2 billion a year treating obesity-related complications, such as diabetes, heart disease, osteoarthritis, sleep apnea, asthma and even some forms of cancer.

Experts have implicated everything from our "fast-food nation" to fat genes, but regardless of what put the weight on, studies suggest that, for the dangerously obese, nothing short of radical abdominal surgery will take it off.

Sometimes drugs such as Meridia or Xenical can help, but they're expensive, costing $1,600 to $2,000 a year.

The intervention with the best long-term result for the very overweight is gastric bypass surgery, says Dr. Bob Dent, head of the Ottawa Hospital's weight management clinic. But there just are not enough doctors doing it.

"There has to be some give on this. Some of these operations have to be made more available to people," he says. "I can tell you that many of these surgeries for grossly overweight people have as much urgency and as much importance as coronary artery bypass graft."

Shirley Spence-Lemore, co-ordinator of the Obesity Surgery Support Group in Ottawa, who had a gastric bypass last July in Scarborough, says the operation is never an "easy way out." Before her surgery, the 60-year-old Ottawa woman could barely make it up the stairs. She couldn't tie her shoes, or get out of the bathtub unassisted. She tried everything, from Optifast to the grapefruit diet. Since the surgery, her weight has dropped from 261 pounds to 180, just 20 pounds from her goal.

"These people who are waiting, a lot of them won't make it. They're so overweight. And it's easy for people not in that situation to say, 'just stop eating. Just shut your mouth. You'll be fine.' Well, it's not that easy. If it was, we would have all done it."

Jean-Pierre Groulx, whose weight once ballooned to 465 pounds, knows the risks he's facing: leaking of his "new" stomach, infections, scarring, blood clots, even, in very rare cases, death.

But he also knows what he is looking forward to: sleeping without a machine that stops him from waking up at night, gasping for breath. Climbing the stairs to bed without thinking, 'Will I need a glass of water?' "Because I don't want to go back down again." Buying clothes off the rack. Walk with his dog. Walking his daughter down the aisle at her wedding next year without looking "like the way I do now."

"For me, this is the final solution."

© Copyright 2002 The Ottawa Citizen
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Old 10-27-2002, 08:44 PM   #2
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thanks for the info, ruth. it's a sad sad situation.

the flip side is, though, that the american college of surgeons met a couple of weeks ago, and EVERYONE is jumping on the bariatric surgery bandwagon. with little or no training, and little or no support or aftercare.

scary times!!!
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Old 10-27-2002, 09:38 PM   #3
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Now that IS strange!

The doc quoted part way through the article is my Dr Bob and was here for dinner tonight. He told me exactly the same thing and is very concerned!

By the way, we ate "normal" food - Bob is a hedonist!
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Old 10-28-2002, 11:07 PM   #4
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I was just browsing through the forum, part of our problem in the Ottawa area and in most parts of Canada is that we lack doctors in general. Although I lost my weight without surgury, my circumstances were far different from many of the people who do require it and it's a shame that there is not enough doctors to help those who need it.

They complain they don't have enough doctors, yet there aren't many places in medical schools (I know a lot of people trying to get in who are smart enough and compassionate enough to become doctors who can't get in).
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