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Are Medical Tourists Jumping the Queue?



Dr. Chris de Gara, Professor , University of Alberta, Edmonton, Canada

Dr. Chris de Gara, Professor , University of Alberta, Edmonton, Canada

One of the new features this year will be essays and opinion pieces that I invite from colleagues (inquiries welcome). They can be quirky, opinionated, one-sided, provocative – anything that will stimulate discussion – perhaps even heated debate.

The following is an “essay” sent in by my friend and colleague Chris de Gara, Professor of Surgery, University of Alberta and Director of the Bariatric Surgery Revision and Medical Tourist Clinic, Alberta Health Services, here in Edmonton. This clinic sees an increasing number of patients who have run into trouble after rushing off to receive bariatric surgery outside the province.

As a Medical Tourist am I a Queue Jumper?

You’ve been on the weight gain/weight loss roller coaster almost all your life. The number on the scales is more like time in the afternoon. Your clothes’ size is the age you would still like to be. You’ve had enough of stares on public transport. Your lace up shoes have all their knots along one side. You can’t even remember when you last crossed your legs.

Enough is enough!

All your GP wants to focus on is your sleep, sugar, cholesterol and blood pressure problems. Surgical weight lists are interminable and you might not even be a candidate.

Time to take matters into your own hands. Friends have done it. The website is attractive, the centre is accredited, the costs are a lot but not outrageous, and you even get a holiday out of it.

But hold, on is it safe? I don’t even drink the water in Mexico! But these Mexican surgeons have been trained in the USA, so that’s good. What are they going to do – a laparoscopic adjustable gastric band – in and out in the same day, only three or four little cuts. And it can always be removed later on. Afterwards few little injections are needed every few weeks to fill the band, which gets done back home. But didn’t you hear that quite a few of these bands need to be removed, although that wouldn’t happen to you. What about the other operations – sleeves and bypasses? Aren’t they complicated, even dangerous, they have to do lots of cutting and sewing; and things are never the same afterwards.

So what about it? I could be normal. Hardly have to take any time off work.

But hold on, what if things do go wrong. After all, any surgery can have complications. Even if the risks are very low, if something happens, it’s happening to me… Who would look after me? Our hospitals work well, if slowly. I pay my taxes. Aren’t I saving the system by going privately, making space for someone else?

But is it really that simple? Why does it take so long to get weight loss surgery? Is it because there aren’t enough surgeons? Or is it that maybe, they don’t want to rush in? Maybe, obesity is really a lifelong problem and long term strategies need to be in place? Maybe, one of the more the more complicated operations would be better for me?

I guess medical tourism isn’t for me, even if I’m not jumping the queue…

Hmm…

Chris de Gara, MD
Edmonton, AB

14 Comments

  1. Based on my own experience, medical tourism can work just fine IF the person puts in the effort to carefully research their potential surgeon and the facilities where the surgery is offered, commits to the long term lifestyle changes needed, is absolutely honest when filling in the required medical questionare and arranges for aftercare before heading out.

    There are “chop shops” that have iffy results and lots of complications. There are also excellent surgeons with as low or lower complication rates than happen when going through local programs.

    There are people who think the surgery is a magic pill and will do all the work. (sorry, not true) There are people unwilling or unable to commit to a lifetime of small, high quality food servings and being ever vigilant about drinking. (dehydration is a very common issue) There are people unwilling to have regular labs drawn, take their supplements (very specific and not always easy to find or cheap), weigh themselves regularly and journal their food in some way.

    There are also people (like me) with the willingness and determination to educate themselves, make the changes, have the labs, take the supplements and monitor their weight and food intake. We don’t generally make the news and we don’t end up at the revision clinic or Emerg with complications. We drink our water, eat carefully, see our family doctors regularly and are very, very happy that we made the choice we did.

    I was turned down locally because after losing 45# (from 304#) I was deemed too “healthy” and unlikely to lose much more even though I was on BP meds and strong pain meds for arthritis and sciatica. I now maintain 187# and haven’t needed those drugs since shortly after my surgery.

    Am I “skinny?” No, I’m actually still obese, but a BMI of 33 is better than the 47 I was on the day of surgery, and a whole lot better than the 52 I was when I started. I can go anywhere, shop anywhere, DO anything I want to, chase my grandchild, live a NORMAL life. Would I do it again? In a heartbeat.

    Instead of trying to scare people away from medical tourism or shame them for being desperate enough to do something so scary (I was terrified, but MORE terrified of the future as I started to regain my weight) how about doing some research and telling people about safe options if they don’t qualify for surgery here? How about offering a self-pay option for those not “sick” enough to qualify under the public health plan?

    Kelly-Anne

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  2. I am a mental health counselor who specialists in bariatric surgery patients. When I decided to work with this population, as a patient myself, I knew I would be subject to criticisms as a clinician. What I did not know at that time was that my lapband was going to fail, and I would need to have it removed in emergency surgery (without insurance in the US, which would end up costing me $31k!!!) After a year of no band, rapid weight gain, and a lot of stress over not having health insurance, I looked into surgery in Mexico only because both Michelle Vicari (The World According to Eggface) and Beth Badore (MeltingMama) urged me to strongly consider it as an option.

    While attending the ObesityHelp conference, the fates blessed me with winning a drawing to go to Mexico for vertical sleeve gastroectomy. I won’t lie, I was nervous and had many reservations. However, I had the opportunity to meet the surgeon, Dr. Elias Ortiz of A Lighter Me, and I ask around about him. A lot. As a clinician and employee of a US company in the field, I had many resources I spoke with and got feedback from before I jumped on the plane there. I even woke up at 4am the morning of my surgery and questioned what the heck I was doing in Mexico about to have a revision, full of fears that maybe I had lots of scar tissue from the band slippage that would make my surgery not-so-cut and dry.

    My mother was with me, so I had my family support system, however, my husband of a year did not and still to this day does not agree fully with my decision to go to Mexico, despite there being no cost to me. Having two weight loss surgery experiences in the US, I will tell you this, some facilities, particularly A Lighter Me/Mi Doctor Hospital, and their surgeons, really know how to implement medical tourism safely and effectively.

    I arrived late on a Saturday morning and had surgery on Sunday morning. The nurse struggled to find a vein for my IV, so my IV was placed just before surgery. Dr. Cardenas gave me a sedative to calm me down, and Dr. Ortiz came in to say hello and assure me that everything would go fine. He continues to check up on me on a regular basis through email and is genuinely interested in my well-being, unlike my experience here in the US where my surgeon saw an out-of-pocket payee to place a band in (2009) and probably saw floating dollar signs for the removal at the same time as well.

    I know good and well that not everyone who seeks bariatric surgery is as low-risk as I was. However, with the proper planning ahead of time, coordinating with your PCP before you go out of the country to have surgery, choosing a reputable facilityand good doctors, medical tourism is not a bad option if you have to pay out of pocket. Many of us in the US are left with only one choice because the unexpected out of pocket, uninsured costs (re: $31k band removal) is not feasible.

    My advice to anyone who seeks bariatric surgery in a medical tourism setting: Be sure you have a primary care doctor assess you and agree to follow up once you return home, proactively have you blood work done in follow up, be your own best advocate if you are struggling and need support post-op, and do your best to lose weight prior to surgery to lessen the risk involved with your surgery. Having a strong treatment plan and providing the surgeons in Mexico with as much information as possible regarding your health conditions and medications will help them prepare for your arrival.

    Some people will find that they want a support person with them. (I did not, my mother insisted on coming with me.) Make sure that person is a calming influence on you and is well prepared to keep you in the right head space so your anxiety is low. Ask a lot of questions of the coordinators you work with before surgery. Take your time to schedule the trip and coordinate your pre-op on the front end with your PCP or bariatrician/provider.

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  3. Wait a minute – there’s actually a clinic called “The Medical Tourism Clinic”???

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  4. People go to Mx because our insurances in the US are covering less and less re wls. Also, asking super morbidly obese, or morbidly obese to wait a year or five years is not only ridiculous in a country that touts WE ARE THE BEST but its asking them to remain obese and take years off their lives.
    I did NOT go to Mx but was fortunate that my insurance and my husbands would cover removal of my 10 yr band, of which I had placed in Nashville, Tenn, and revise me to the sleeve. I kept the majority of the weight off that I lost with the band. Our health suffers, our emotional and spiritual parts of us suffer as well. The lap band was over seas many years prior to it becoming available in the US and it was also in MX way before the US. Is that the US being safe or selfish???
    Im sorry but unless you’ve walked in my shoes, pre band 486 lbs, thyroid disorder, bp issues, diabetes at age 48 etc, your article is void of that knowledge.

    You are in Canada? Your waits are much longer which your system and surgeons should be ashamed of! Im all for education and knowledge and I did my research but some have mentioned up to a 3-5 year wait??? Do you rrealize how much those years of remaining obese take off our life and add to more medical issues and in the long run higher costs to our insurance??? That in the US gets passed on to us, the consumers. Our wages are low, many comapanys now only hiring part time due to Obama Care and many, many living under poverty and cant get up from it.
    You live in a different world. I would gather to venture MX is probably safer, with the right surgeon, and better care than most get in the US.
    Again, youre in Canada…We are a million miles away with health care and opinions.
    I just think you need to walk in some of our shoes for a minute.

    Also if you’d rather we didn’t go to MX…make it available…advocate for all of US!

    tia

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  5. Medical Tourism equals ‘A long winded nightmare’ it caused myself and family an incredible amount of emotional, financial and physical stress.
    The surgeon we opted for was on The Oprah Show ….not sure if that meant he was Oprah endorsed but it felt like another good reason to go forward with him.
    His clinic was incredibly clean, comfortable, spacious and modern….my husband and I for some reason ended up paying for our teeth to be whitened in his clinic the morning of my surgery?? I guess seeing the armed guards escorting the surgeons mother to the parking area made me decide to be a ‘Yes Sir, No Sir’ patient! The hairs on my wooden leg told me something was up.
    The band was place in error above my stomach, after many phone calls, trips to have the band filled / emptied even flying to Grand Prairie to have it done under fluoroscopy didn’t make a difference. Cost of fills alone $3400. I should really work out the time, milage and costs over the years that ridiculous trip to Mexico cost us. Many days wasted, all time that I cannot get back, the depression, the sickness – what a big mistake, a huge drain.
    I then flew to Toronto and had it removed and replaced and approximately $40,000 later nothing had changed apart from nice chunky scars, depression, financial trauma and excruciating GERD and still I wasn’t getting restriction. Just drinking more.
    After a referral to the Weight Wise clinic and time to reflect, coaching, counseling, education and probably nearer two years it was agreed that I was ready for revision surgery.
    Now I am on the the road to recovery, I have the professionals (not sure if its Bodie or Doyle more like Bodie) to guide me. The weight is going steadily its not a miracle and doesn’t just go , the biggest loss that lightens my day is the emotional burden that has been lifted.
    The daily chest pain has also gone…..not good standing on your nipples
    ( c’mon lives to short not to have a titter, I’ve been through the wringer the last few years and have the flappy flap boobs to remind me!!)
    ThankQ WeightWise and Dr Chris

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  6. I work in the health care system, and have seen cases where people who choose to go outside the public system (not necessarily for bariatric surgery) end up with problems that are ultimately cared for in the public system–the patient who chooses to go outside the province for surgery but the necessity for travel to do so aggravates their condition so they end up admitted to hospital for pain management. The patient who opts for a private clinic for their joint surgery but doesn’t recover and rehab as quickly as their private clinic expects–that patient is also booted back into the public system to finish their rehab, or to manage complications. So, they end up not saving the public system any money because they are still using the public system, and to top it all off they have jumped the queue–instead of waiting like the rest of us, they have their surgery privately yet still end up taking up space that someone else on the wait list could have used! Not saying this always happens, not sure what is the best solution–but it is something to think about.

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  7. I had bariatric surgery (lapband) outside of Canada 3 years ago. Living in BC, it was simply unavailable to me under the Canadian system. I have lost over 100 lbs, still losing, I have not cost the Canadian system one dime due to my surgery, likely I have saved the system a great deal because my health has improved so tremendously. My contact with fellow ‘losers’ with lapbands indicate similar positive life changing success. Not all of us lose ALL the weight we hoped to, I’m stlll at it, but absolutely confident that I will. Telling me to wait , and not ‘jump the queue’ would be condemning me to further years of pain, humiliation and declining health. No thanks. The Canadian health system could not meet my health needs, it has other priorities, so be it, I have no regrets. No one makes such a decision lightly, for the risks, for the considerable amount of money it takes. With respect, to dissuade people from doing what they can to improve their health , even if it means moving outside the Canadian system, cannot be considered to be good medical advice. FWIW, I am immensely grateful to my surgeon.

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  8. Thanks to all for your comments regard my piece
    These are important discussions to have.
    Of course there are important differences between US and Canadian healthcare. A point of accuracy, once approved for bariatric surgery the wait time is 6 months, not 3 -5 years!
    However, the message I really want to get across is not that perfectly successful surgery can’t be performed out of country, of course the vast majority go well and are successful – it’s about who picks up the pieces if it doesn’t.
    But most importantly my message is that bariatric surgery is merely a tool – if done in isolation with out the appropriate supports of dieticians, psychologists, exercise specialists, nursing, dedicated physicians etc, short and long-term failures are going to be high.
    thanks again for you comments

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    • So what your article should be stressing is that if you do choose to go out of the US to find a physician, you should research, research, research, and then do some more research, to find the physician who will follow up with you and advise you what you should do in worst case scenarios. Also to make sure that you have a good medical support team here in the US in cases of emergency. Until the US physicians are willing to come down on the cost of the surgeries here, there are going to be many people, myself included, who will be desperately flocking across the border to have these surgeries. Until the physicians will quit penalizing the self pay patients and quit trying to make up the difference in cost between the cost and what the insurance companies pay on “insured” patients, self pay patients will continue to go where they can afford to have the procedure performed. If the physicians are so concerned with people crossing the border to have “sub-par” medical treatment, give the patients the same cost point and let us have it here. The uninsured (or insured but not covered) patients end up paying twice as much as what the insurance company and insured patient pay combined because of the contracted rates that insurance companies pay. Insurance and insured patient will end up paying maybe $6,000 – $10,000 combined on a surgery that a self pay patient has to pay $25,000-$30,000 for. Mexico sounds like the better deal. I got my surgery for $4,600 + plane ticket. If I would have been offered the same surgery here in the US for $6,000, I would have done that simply for the convenience.

      Sincerely,
      A Medical Biller & “Queue Jumper”

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    • Some of us don’t have a choice. I had a consult with my Dr today and was told he wouldn’t do a revision on me because the risks outweigh the benefits for me. sure I’m not 400lbs, I don’t have diabetes or sleep apnea but why should that determine my quality of like. I just spent 8 months going through tests, questions, food journaling and appointment for nothing. Getting my hopes up and actually looking forward to life again. All for nothing! Mexico is my only option now or wait until I develop those problems and try again. All AHS talks about is prevention but not in this case I guess. I can’t even get the 2 fistula’s repaired that are the reason for the weight regain. I’m so disappointed. To me it makes more sense to dobthevrevision surgery on someone that has a good chance of making it outbid surgery alive rather than someone going into it with existing problems that will definitely result in complications. It just doesn’t make sense.

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  9. Unfortunately, many Canadians are left with no choice to look to medical tourism for help. The waiting lists in Nova Scotia are ten years and a minimum of 5 years in New Brunswick. I had a VBG (vertical banded gastroplasty) in Halifax in 1996 and lost and maintained between a 150 – 200 lb weight loss for over 18 years. Eventually as is the case with these surgeries I failed and I began regaining my weight. I was referred from the Maritimes to the Bariatric Revision Clinic at the Royal Alexandra Hospital in January of 2015. I was in touch with the clinic and had a scope done back home and called Royal Alex to assure receipt of all needed documentation last summer. Then when I arrived in Edmonton And went to the clinic in Sept I was told the doctor sent the scope in French so it would have to be redone here. It was not performed until April 28, 2016 ( almost nine months later). I was told it was because my own doctor who was away on maternity leave needed to preform the scope. Nope – she didn’t.

    On May 4th, 2016 I met the surgeon only to be told the earliest date surgery could be booked is January 2017. Having read Dr Sharma’s posts about weight times and AHS website listed wait times and still having no actually surgery date I am more than disappointed. I weight 450lbs before I was 30 years old and due to my on hard work and VBG I was able to be a size 18 and not housebiund or a diebetic for the last 20 years. I’ve lost 64 pounds despite a metabolic test MedGem showing my metabolism burns only half what it should, and having hypothyroidism and still I am left waiting in limbo.

    I’ve basically decided after today to start a Go Fund Me campaign and go to Mexico for surgery as there seem to be no other options left. I’m only one person trying to get help in this system. Hope this partly explains why people have to take matters into their own hands and resort to medical tourism.

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  10. Just to clarify a couple of typos – the surgery failed after 18 years – not me. As you know, VBG is no longer performed even in Mexico or Brazil due to it needing revision after 8-10 years. I made mine last 18 years.

    The 64 pounds I lost were between Sept 2015 and May 4, 2016 – meaning I am still 154 lbs lighter than prior to my VBG in 1996 however since I started at 450 pounds I still weight 296 pounds. Nonetheless, I’ve used My Fitness Pal (free app for iPhone) to track all exercise, food and drink and have since the dietitian told me about it Jan 4, 2016. I have missed no appointments and worked with an endrcrinologist and dietitian back home for 6-8 months before being referred to this program. And yet I can’t even get a surgery date. What options are left for me other than finding the money and leaving the country and having a RNY? If I’ve missed any options within Canada I’d be more than happy to investigate them.

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