The gastric bypass process in Ontario (roux-en-y)

I am in the gastric bypass pre-op and assessment process in Ontario, Cda. I wonder if there would be any interest in blurbs from me as I proceed to the operation or rejection over the next several weeks. Roux-en-y has been found by several reputable medical studies to arrest t2d symptoms about 85% of the time, and patients typically lose about 80-90% of their target weight loss. I’m a t2d that was in pretty good control for the first 10-11 yrs. thru drugs and diet/exercise, and 2 yrs ago, the meds stopped working, so I’ve been on insulin. I take 5 shots a day, and my last A1C was 6.5 = optimal control, but nevertheless, I want to have the operation to stop the t2d progression and lose a lot of weight - I’m about 100 lbs overweight. I’m in a metabolic diet and exercise program now, and have lost about 15 lbs. but have doubts I can lose much more with it. I have a blog that needs some updating, and I will be adding to it regarding this process when time allows. In Europe, I understand this operation is common, with great success, but our big pharmas in N.A. aren’t keen about losing all those dollars in drugs and testing materials and equipment. However, the operation is serious surgery, though quite safe, and the post-op regime for eating is drastic - very restrictive for a very long time if you want to avoid problems and stomach stretching and weight gain. I believe more t2ds should consider this surgery as a real option.

P.S. In Ontario, about 95% of the cost is covered by medicare if you’re accepted for the operation. In special clinics in the U.S., the believe the cost is up to $60 K. One doctor in Montreal does private surgeries, charging from $15K to $22K, but he is retiring soon, and his private line might be closed now or it will be soon.

Would be interested to read your experiences pre- and post-surgery.

This type of metabolic surgery seems to be more effective in achieving type 2 remission (although lifestyle changes must be maintained for life and eventually return to some meds, albeit less, may be necessary) than the LAP-band procedures.

Real option - yes. Other choices - are out there as well. While overweight (not enough to qualify for bypass surgery) I, myself, would not consider gastric bypass due to the life long implications it leaves you with - multiple daily protein supplementations (or your body will go into starvation mode), malabsorption issues, etc. I think the decision to have this surgery is very individualized and a LIFELONG committent to the lifestyle it creates. Not all people can handle this lifelong committment. While I would love to loose a great amount of weight, I know I couldn’t commit to this lifestyle.

Your points are valid - it is a trade off, but I’d rather take protein supplements than 5 insulin shots a day, lots of meds, periods of sub-optimal control or worse, and the relentless progression of diabetic damage to heart, circulation, eyes, kidneys, extremities, etc. that even t2ds in good control will incur. Every year, they lower the safe or optimal level to be relatively free of progression - it was 9 when I was first diagnosed, then 8, then 7 and now they want us in the sixes - well, that ain’t easy either.

Have you thought about a Lap Band? I have one, and my progress has been pretty much like my friend who had gastric bypass. Lap band does not require ANY cutting or rerouting your body systems. I was out of the hospital the same day, where my friend was in ICU for 24 hours. She has to drink protein supplements, take mega vitamins because her body does not process certain things properly. I do not. So, please look into other options than something so drastic.

Well, I’ve researched the options quite thoroughly. Lap banding is not done by medicare here, so it is a cash outlay of around $15 - $20k. Second, lap banding does not have the same effect on t2d as does roux-en-y - not even close, according to all the studies I have read about. Also, lap banding is effective to a lot less weight gain, and the weight loss achieved is not as stable as for roux-en-y. Roux-en-y uniquely affects t2d due to hormonal changes, some scientists think. So, like all treatment options, there are trade-offs.

Just investigate what the surgery does to your body. Remember, weight loss surgery does not mean you do not have responsibility for what your eating habits are. You have to work with it. It is not a solution to being overweight, but it is a tool to help you change the habits which caused you to gain weight. I have heard from some many who thought once they had the surgery, they no longer had to watch what they put in their mouths. All because you can not eat much at one time, if you truly have an eating disorder, you will eventually find ways to “beat the system”.

Anna, I think I’ve made it apparent that I have done a lot of research on this over the last two years or so. I am well aware of the post-op regime and limitations. I also think you should do some research on t1 vs. t2, as your emphasis on bad eating habit and eating disorder belies an ignorance of the causes and remedies for t2. I see you are a t1, and very frankly, I am a bit weary of t1s giving such advice to t2s based on obsolete stereotypes and misinformation. More fodder for my view that t2s are shy about coming out and expressing their views and concerns, because uninformed people jump on them for having bad eating habits or eating disorders. “the habits that caused you to gain weight…” - your words. It is exactly that kind of accusatory judgmental tone and approach I find just a bit offensive. But, it is typical of the uninformed and very often, t1s who of course can take the high road because they are the blameless victim of genetics.

I think you are missing the true nature of this site. We are all free to add our opinions. FIrst of all, what the heck is this t2s and twhatever. I have never heard of these terms. I too am a vittim of genetics, so I guess I missed that point in your post as well. I have been obese for the majority of my life, and the comment you mention above reflects my opinion of myself, and in no way reflects what you may experience. I guess my point was that having ALSO RESEARCHED weight loss surgery, there are good points and bad points about any surgical procedure. Listen, I weighed well over 300 pounds, now I am in the 200’s. I am still considered obese, so please do not tell me that I think. I just wanted to point out that there are many things to consider, and apparently you know all there is to know. Now that the heck is a t2s???

First, t2s or t1s is shorthand for type 2 and type 1 diabetics. Look at your words to me: you referred to my eating habits or eating disorder, that is what you said, I didn’t make it up. You told me to research, when you had no ability to judge the quality of my knowledge. When it comes to roux-en-y and t2d, my knowledge is pretty good, not exhaustive. It’s fine to express an opinion or to refer to your own experience, but look at your words to me. I responded to that, and my comments stand. I don’t need any coaching from any t1s, thanks anyhow.

May you find peace and happiness in whatever you decide.

" I believe more t2ds should consider this surgery as a real option." No offense, but I would never consider this as a real option any more than I would casually go for an organ transplant, if I wasn’t in real danger. I have met diabetics who regret having gotten this operation for all of the awful complications they are now enduring (even though they lost 180 lbs), and I know many who have died on the operating table. It is just not worth it… my family needs me. I strongly feel this is an operation only people who are in serious ranges like 450 lbs+ should consider, where the mere stress of the weight could kill you as well. I have a friend who weighed about 500 lbs when he got it, and yeah, he is thinner, and out of many dangers, but many other dangers have also cropped up. He has had to have many, many continuous interventions to deal with them. It is a serious decision to make, and I wish doctors would restrict this a little more… because if you just have a 100 lbs to lose, it’s not worth it.

oh, and I believe I was speaking metaphorically when I used the words you, etc. Again, live well, and be healthy!

Thank you, Lizmari. I think that was the point I was trying to make, that seemed to upset this nice gentleman.

I could also add that I am a type 2 with 147 lbs to lose, of which I have lost 43 already, all on my own… It would be ridiculous for me at this weight, to go on some surgery. It’s not worth it. The effort in portion control and exercise is worth it. Dying on the operating table cus I wanted to lose 100 lbs without doing anything much, like my best friend’s mom, is NOT. She left 13 kids behind, and a husband to deal with it all by himself. It’s only supposed to be an emergency, last resort thing.

Sorry, Grant, this won’t be of much help in Canada, but adds to the discussion for people interested in gastric bypass in general. I’ve just finished editing a story on the topic, so some stats are fresh in my mind. In the spirit of full disclosure, I am a type 1 and I have not had nor considered weight loss surgery, my BMI is just barely into the overweight range, and I think that both type 1s and type 2s have things of interest to share with each other. :slight_smile:

U.S. Medicare will pay for metabolic surgery if you meet the eligibility criteria (BMI greater than equal to 35 and have type 2 diabetes, heart disease, or sleep apnea) and have surgery in a Center of Excellence. In early 2009, Medicare added type 2 diabetes as a condition that qualifies a person for surgery. Centers of Excellence are certified by two organizations and can be located online: American Society for Metabolic and Bariatric Surgery and American College of Surgeons Bariatric Surgery Center Network. A surgical Center of Excellence does the proper pre-surgery and post-surgery psychological, nutritional, and physical activity support that is necessary to have a successful outcome.

You and I are entitled to our opinions and the ability to express them. However, I strongly disagree with your views on the pros and cons.

How in the world is taking some supplements and vitamins worse/more dangerous/more cumbersome than having to take diabetes drugs and 5 shots of insulin a day? One way or the other, t2rs must change their lifestyle to survive.

If you get the roux-en-y, which is not at all like the old stomach stapling, you certainly must adhere to the program, or pay the price. But you are quite wrong about the risk of mortality with laparscopic (spelling?) roux-en-y type surgery developed and perfected in Europe. It is as good or better than lap banding in fact.

One very large factor is that with every large, long term study that comes out, the experts specify a new, lower limit to qualify as optimal control. When I was first diagnosed, in 98, they said, keep it less than 9. Then, a while later, it was 7-8, and now it is 6 or below. The obvious point is that the various diabetic side effects - heart, kidneys, eyes, circulation, etc. relentlessly progress even with optimal control. And let’s be honest folks, very few of us maintain optimal control at 6.5 for 365 days of the year, year in and year out. And so, your body is deteriorating all the time.

It is a fact that roux-en-y causes full or nearly full remission of t2d in about 85% or more of people. Lap banding does not have the same effect at all - your sugars may go down because you’re eating less, but that’s all that happens. Roux-en-y changes your system, and for reasons not fully understood, it arrests t2d - some think it’s hormones.

Lap banders learn how to cheat the system and expand their stomachs, complications can arise with it, too, and the weight loss is both less in % and less permanent. Don’t tell me you “know many people who have died” - I just don’t believe you, as the mortality rate is now so low. Also, you don’t know about the intense assessment and pre-op testing that goes on under the OHIP program here in Ontario, as well as the broad and intensive post-op care and monitoring.

If you knew about the Ontario OHIP program, you would be compelled to change your view - but, I’m not here to sell anybody anything. I could care less if anyone else does it. There are those out there, especially in the U.S. who have a lot to lose - billions of dollars - if roux-en-y becomes more popular than there drugs and blood testing equipment, and their lap bands. Just like the b.s. spread in the health care fight in the U.S., the vested interests will spread lies, sponsor trojan horses to oppose competition, try to discredit the roux-en-y practitioners, and do anything to win the battle.

Under the OHIP program, they don’t accept people who are more than 350 lbs (with special exceptions), as they regard people with much lower BMIs as better candidates for success. To anyone who thinks they can lose 100 lbs by dieting and exercise, good luck to you! You are the 1% that can do that, and a smaller group that keep that weight off for more than 12 months. You should be able to sell your story and photos to People Magazine, because it’s a rare achievement indeed!

If you saw my diet for the last 10 yrs, you’d be amazed how little I eat. So, how far lower can I go to lose serious weight? How much more do I have to exercise?

I didn’t say don’t do it… I said don’t go saying more T2’s should consider it, like the rest of us can’t manage with diet and exercise. Lots of people can do it, and have done it, and tell it on this site, day in and day out… Including my own father. I honestly do not care if you believe me; but to think this is somehow better than doing it by simple diet and exercise is naive. Convenient, yes; the last straw… perhaps. Better? No way in hell. Any doctor can tell you that. Good luck to you, and I hope you don’t have more problems from it, for your own sake.

Grant, It is beginning to sound like you are more trying to convince yourself of something. You keep saying I am a t1s, however that is because I was "upgraded to that by labs, not by birth. I more consider myself t2. I see a lot of hurt and anger in your posts, and hope that you can find whatever peace you are searching for. I know I make excuses about why I have been overweight, and am really trying to do what is best for me only. You have to do what is best for you, and it should not matter what others think, because it is your decision to make for yourself.