Jill W.
October 25/2006
This is my letter to OHIP. It is my story.
I submitted this letter as supporting documentation for my application. It was submitted on October 10 and I received the approval on October 19th 2006. I am waiting for my info session and appointment with the surgeon
Tuesday, October 3, 2006
Medical ConsultantMinistry of Health and Long-Term Care
Re: Prior Approval Application for Full Payment of Insured Out-of-Country Health Services for XXX XXX HC # ######
To whom it may concern:
My doctor and I have discussed Bariatric Surgery in length and after extensive research and careful, thoughtful consideration; I would like to meet with a surgeon to discuss my suitability for the surgery. Today I called the office of Dr J, a Toronto Bariatric Surgeon to inquire about the wait time for surgery. I was informed I would have to wait in excess of ten years. Another option presented to me by my doctor is a referral to a surgeon in the USA. I would like to present to you my obesity and weight loss history and current health condition. This will give you an indication as to why I would like you to consider me a candidate for full payment of insured out-of-country health services for bariatric surgery.
I am thirty-eight years old; I have a husband, a five-year-old daughter and an almost three-year-old son. I currently weigh 142 kg, and I am 160 cm tall, which is a BMI of 55.3.
I work full time for XXXX. My current assignment is at XXXXX, an in house training department. I assist in the development and delivery of computer software training and other divisional training initiatives.
There is a long-standing history of obesity in both my maternal and paternal families. Both my parents are morbidly obese and several aunts, cousins and my brother range from overweight to morbidly obese. My grandparents on my maternal side were obese. Weight loss programs and dieting were common in my home. At age four, I remember my father taking a picture of himself to be the ‘before’ picture in his latest diet attempt. ‘Tab’ diet cola was the only cola beverage we had in the home. I did not recognize that I was ‘fat’ until grade one when we were having a contest to see who had the biggest belly and I won. Later that day I was teased and I realized that having a bigger belly did not make you a winner.
At age fourteen, I tried my first formal diet. I followed the Dr Atkins’ Diet Revolution, ate only protein, and tested my urine to ensure I remained in ketosis. I lost about 15 kg. I considered it a successful diet. Over the next 6 months, I gained back the weight and found myself at a higher weight than when I started the diet. Next, I read several weight loss books and tried each new diet for while; losing weight and eventually gaining it back. At age sixteen, I joined Weight Watchers, which began a cycle for the next twenty years.
In 1985, my father was hospitalized for sleep apnea and he weighed nearly 180 kg. As an emergency procedure to treat the apnea, he had ‘stomach stapling’. He lost over 90 kg. He has experienced complications in the past ten years however, he stated he would have weight loss surgery again, without hesitation.
I can recall my weight at personal milestones though my life. At age seventeen, I lost weight when I was at Junior Ranger Camp and kept it off for approximately six months. When I graduated high school, I weighed 90 kg. After my first year of university, I weighed 115 kg. I rejoined Weight Watchers that summer and lost approximately 18 kg. I continued through university joining and rejoining Weight Watchers and doing low impact aerobics. I went to student services for assistance with dieting and I graduated at a higher weight than I started. (about 120 kg)
My next weight loss attempted was during my contract as a nanny in Switzerland. I did not prepare my own meals and in adapting to the culture, I walked and exercised regularly. I joined Weight Watchers, in French this time, and when I returned to Canada twenty-two months later, I weight 96 kg. A year after my return to Canada I had regained the lost weight and exceeded my starting weight.
I weighed 139 kg on April 8 , 2000, my wedding day. At that time, I had decided to try a different program and I joined Jenny Craig. Unfortunately, I had a gallbladder attack and I stopped the program until after surgery. I attained 127 kg following the Jenny Craig program and a fat restricted diet waiting for gallbladder surgery. Shortly after the surgery, I became pregnant. I tried to eat well but discontinued formal dieting. After the birth of my child, I started on Merida. I did not lose a significant amount of weight yet I felt the Merida kept me from gaining back the little I had lost. After the birth of my second child in the fall of 2003, I weighed about 148 kg. I reached my personal maximum, non-pregnant weight of 163 kg in the fall of 2005. At that time, I was seeing my family doctor bi-weekly for weight check-ins and I was following his diet regime. I was receiving treatment for depression.
December 2005, I was referred to Dr XXXX. This was a life changing experience for me. He changed my medication to enhance the treatment of the depression and did ADHD pre-screening. He referred me to Dr XXXX, a psychologist, who diagnosed me with ADHD. I began treatment for the ADHD in early 2006. With the medication and ongoing counselling, I have been able to bring my weight down to 142 kg. I meet with a nutritionist who is familiar with ADHD to assist me in setting realistic goals for menu planning and food preparation. We continue to work on positive habit building and the recognition of behaviours that lead to overeating and making poor food choices.
Despite my recent successes with changing my eating habits and improving my food management, I feel the success has come too late. I suffer on a daily basis from the past thirty eight years of weight loss and weight maintenance failure.
I have the following co-morbidities:
· Plantar fasciitis and general foot pain: receiving treatment from podiatrist, chiropractor and Register Massage Therapist (RMT)
· Knee strain and pain in calf and knee: I use a cane·
Obstructive Sleep Apnea: CPAP set at 11 cm H20
· Asthma: I use puffers when needed
· Stress incontinence: especially prevalent in the mornings when I cannot walk well as I have acute pain from plantar fasciitis and my knee
· Pre-diabetes (impaired glucose tolerance): I am taking Metformin
· Hypertension and increased risk of heart attack and stroke
· Early cardiovascular disease
· Deep vein thrombosis risk: I received heparin shots when I was in the hospital following the delivery of my children
· Easily fatigued
· Yeast infections and maceration with skin folds: treated with Loprox
· Skin tags: numerous on neck and under arms
· Depression and poor self-esteem: I am taking Celexa and Wellbutrin
I developed Obstructive Sleep Apnea and started using a CPAP system in 1999. I have had numerous sleep studies and I have seen my pressure start at 11 cm H2O and drop to 9 cm H2O after tonsil and adenoid surgery. With weight gain, the pressure setting has been increasing and now is 11.5 cm H2O. In my bariatric surgery research, I referenced the Ontario Health Technology Advisory Committee (OHTAC) recommendation, completed June 16, 2006, concerning Polysomnography (PSG) in Patients with Obstructive Sleep Apnea (OSA). OHTAC found that the assessment of PSG in OSA patients supports the earlier recommendation that morbidly obese Ontarians be provided with increased access to bariatric surgery (referring back to their earlier recommendation of January 2005). I feel these recommendations and the threat of more serious health complications and possible death due to my co-morbidities; support my request for your consideration for me to have timely access to bariatric surgery.
In addition to the physical risks of obesity, I face significant psychosocial effects of morbid obesity. I have experienced ostracism in social situations and at work. My family suffers by association. My daughter is teased about her mom who has a ‘really fat bum’. She hears strangers making comments to me as I pass them in the grocery store or when getting to a seat in the movie theatre. She asks me to go with her on her field trips at school and daycare. I cannot accept because I cannot walk and keep up with the class or sit on the ground for a picnic. Last summer I was asked to help coach her baseball team but I declined, as I could not stand for the duration of a game. I fear that my young son will run into traffic and I will not be able to catch him. I cannot be the mom I want to be. My husband has to do most of the household chores as I cannot physically do them. Our marriage is not the equitable relationship we agreed to when we were married.
At work, I have had to turn down opportunities such as accepting an award at XXXX. I am unable to meet the physical demands of staffing a booth and walking through the Metro Convention Centre. When I am facilitating a workshop, I cannot walk around the classroom to assist the learners, as I cannot fit around the chairs and tables. I usually have to sit during the presentations and this is affecting my effectiveness as a facilitator. Although it has not been said, I feel my ability to achieve a promotion has been compromised by my size and appearance. Due to my poor physical health and depression, I have a greater than average number sick days. My immediate supervisor has indicated that if I have any additional sick days without prior approval I will be admitted to the Attendance Management Program. Admission to this program will adversely affect my ability to obtain future promotions and approval of transfer requests.
With the continued treatment of my depression and ADHD combined with counselling, I am confident I will be able to maintain my current weight, and possibly achieve some weight loss in the future. However at this point in my life, I feel I am swimming against the current. I am learning how to swim much more effectively yet I cannot reach the shore. I will not be able to reach the required goal of an additional 80 kg of weight loss, and maintain the weight loss, without surgical intervention. This weight loss is essential if I am to avoid further irreversible tissue damage and a decline in my health and my quality of life as a direct result of conditions either caused or exacerbated by my morbid obesity. I truly do not feel I will survive the ten year wait in Ontario for this life saving surgery.
Sincerely,XXX
