Thursday, July 28, 2011

Medicine isn't about blame, it's about treatment


Yesterday this blog saw a guest posting from Lillian, a Nova Scotian who fears she'll likely die before she reaches the head of her province's 10 year cue for bariatric surgery.

A great many folks left comments (both here and on my Facebook page). Some were supportive. Some were full of self-righteous indignation. Others I chose not to publish as they were incredibly rude and hurtful.

The bottom line for virtually all of the upset commentators was that Lillian just ought to do something. That she ought to fix this problem herself. That clearly she'd just given up. That she wasn't trying hard enough.

It was the good ole, pull herself up by her bootstraps and take things into her own hands crap, or a variant of I did it, so so can she, and while I'm thrilled for the folks who've experienced their own successes, they don't necessarily translate to others.

For readers who don't know, I'm not a surgeon. I'm the medical director of a behavioural weight management program. And while I've seen with my own two eyes many a person lose enough weight to preclude surgery, I don't delude myself into thinking that downloading the solution to extreme obesity onto personal responsibility is everyone's answer.

If there were a non-surgical, reproducible and uniformly effective plan for the management of extreme obesity, I'd agree with you, but the fact is, there is no such plan.

Of course, even if you do want to embrace personal responsibility as the sole cause of obesity, medicine isn't about blame. We patch up drunk drivers and folks who don't wear seat belts. We offer smoking cessation programs. We treat asthmatics who don't bother keeping up with their puffers, pneumonias exacerbated by the early discontinuation of antibiotics, and the psychotic breaks of folks who stop their antipsychotics.

Oh, you want surgical examples?

How about lung reduction surgeries in smoking induced emphysema; liver transplants in former alcoholics; or how about one that doesn't involve a so-called vice at all - heart bypasses on folks who simply didn't bother to take their blood pressure, cholesterol or diabetes medications?

We operate on them all in a timely manner, and so we should, and the public doesn't generally say boo.

But yet in the case of bariatric surgery, many people are up in arms about its timely provision.

Why?

Because for obesity, many folks feel justified discussing its treatment on the basis of blame based causation.

The thing is, aside from obesity it would seem, medicine isn't about blame, it's about treatment, and if there's a proven and viable treatment option, at least here in Canada, people believe it should be readily accessible by our heavily taxed population, regardless of how and why their conditions developed in the first place.

At the end of the day, Lillian rightly sees bariatric surgery as hope. Emotionally it would see her bolstered by a success which for whatever reason, and it's not for anyone to judge, you haven't walked in her shoes, has eluded her. Economically it would save Nova Scotia likely tens of thousands of dollars of care and may improve the Province's GDP by increasing Lillian's ability and duration for gainful employment. Statistically and medically, it will prolong her life, cure her diabetes and sleep apnea, and potentially provide her with a springboard to retool her world, meet her grandchildren, and enjoy a fuller life.

Can you think of any other area of medicine, with an equally dramatically effective treatment option, where people would feel comfortable preaching about personal responsibility trumping a patient's desire or right to access said treatment?

I sure can't.

Lillian shouldn't have to wait 10 years on a wait list for a gastric bypass, and blame has no place in the ethical practice of medicine.

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28 comments:

  1. To answer your (I'm assuming, hypothetical) question: Lung cancer is a health condition for which people offer little sympathy to the afflicted. AIDS, sadly, is often still another example of a health condition where the patient is seen as having done this to themselves.

    Here are the issues with the self-penned obituary from your reader yesterday that may have stirred up the "crap" that I and some other commenters dared to say (not that readers are entitled to all the details of her life, but she's putting herself out there publicly and without all the facts, yes: she is going to be judged):

    The woman's weight or age


    How long she has been overweight


    Any legitimate medical issues (hypothyroid, pituitary tumor, metabolic syndrome, etc.) that cause weight gain/retention with which she has been diagnosed


    Prior attempts at losing weight and what the results were


    If her physician has recommended the surgery or if she decided on her own that it is necessary


    Her tone is utterly blame-filled, self-serving, self-pitying and DOES ABSOLUTELY convey the feeling that she feels entitled to surgery on demand and in the meantime she will continue on her self-destructive path while chanting "It's not my fault!" Whether any of this is true or not, THAT IS HOW SHE COMES ACROSS.

    Weight loss surgery does offer hope. No one is saying she should not consider the surgery if it's medically indicated and appropriate for her. But we're not convinced that it is because instead of offering up a documented medical/psych history of her problems with eating/weight, all we get is the violin, poor me, you mean people will all be sorry when I'm dead, if only you would fix me!

    Even in the US, getting weight loss surgery takes TIME; you don't just tell your doctor you want it and she says great! And books you with a surgeon. I have two friends who have had it. After approaching their doctors, they waited months to see a surgeon. Then another few months to meet a psychologist. THEN the approval process with their insurance providers began, and those reviews took at least six months (both were eventually approved). IN THE MEANTIME, both my friends were required by the surgeons to begin a health & wellness program through their respective hospitals, which required weekly progress meetings. Both were required to lose 50-70 lbs. ON THEIR OWN through diet and lifestyle changes before the surgeons would operate on them, regardless of insurance coverage. So both waited nearly a year from beginning the process to being approved for the operation, and then waited another two months to schedule the surgery and in the interim, LOST significant amounts of weight independently through...diet and exercise. WHICH THEY BOTH INSISTED HAD "NEVER WORKED BEFORE"...so there's the accountability factor we keep debating.

    YOUR reader/friend, in the few paragraphs you devoted to her, unfortunately comes off as having given up and planning to continue down the path she is on as some sort of "I'll show YOU!" to your government and the public. Is that her true attitude? I don't know. But it is absolutely the message conveyed by yesterday's post.

    I stand by my "Crap."

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  2. True. I am VERY much against smoking and am dismayed when I see young people smoking. But when I worked in Oncology and a long term smoker came in with the many types of cancers, especially lung cancer, they became an individual - not a smoker. I helped them through all the nutrition demands needed to get through treatment.

    Yes, I think obesity is preventable. Once that individual is in front of me we have to deal with the problem at hand, not what could have been.

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  3. Anonymous7:52 am

    Amen! I am sure we all know people who think that lifetime smokers should also be denied health care - that is always viewed an extremist unacceptable attitude - so why is it that thinking that the denying life saving treatment to the obese is acceptable. Cigarette commercials are banned - but yet we are bombarded by advertisements for unhealthy life threatning foods on a daily basis -no one Big Mac or DQ Blizzrd won't kill you but neither will one cigarette. We as a society have caused this disease (statistics prove that) so we have a responsibility to cure it, to curb it to modify our world to reduce it. Back to the tobacco comparison again . . .

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  4. Anonymous8:06 am

    Honestly, what turned me off from the woman's "Obituary", was the snarky, pissed-off, "woe is me, I'm over-weight and have to wait 10 years for surgury, in which time I'm going to die" attitude she had.

    Ok, her government won't support/add the treatment onto their list of services. Fine. Instead of writing something as asinine as a psudo-obituary, she could be going around door to door, asking for signatures on a petition. She could set up a booth and hand out literature to get the word out. (Just forget about contacting your local government; it's the knowledgable people in other departments that respond, not the Minister of Health or the Premier. They just put their electronic signature on it after giving it a cursory glance.)

    Really, it was just her tone that urked me so much. When I read it, it sounded like she was throwing in the towel, giving up, and honestly not giving a damn anymore. There were better ways of writing that obituary than resorting to the lowly snarky and sarcastic methods she did, which don't get much attention in this day and age.

    Maybe she is canvassing her government, walking more, eating less, trying to lose some weight in that 10-year waiting period. Maybe she has enough money to go across the Canadian provincial boarders or even the US borders in order to get this surgury. That was not said/made clear in her obituary.

    It simply came across as a pathetic, forgettable, insignificant way to get the government's attention on this issue.

    My two pennies worth.

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  5. Anonymous8:35 am

    As Norma had mentioned in her post we were given limited information and made our opininos based on what we had available to us.

    I live in Nova Scotia. I see people every day dragging themselves off to the doctor to have them fix this issue or that only to leave the office and live in a way that counteracts the medicines/ treatments. (I'm sure this isn't a NS issue just adding that fact to the mix)

    One of my grandparents died a few months ago with a host of what I would consider nutrition related diseases. She had high blood pressure and fluid retention and was taking meds for it and would indulge in every salty, fatty food she could as soon as she left her doctors office. I see her children all struggling with medical issues (high cholesterol, high blood pressure, type 2 diabetes...) I do not want to be on that path so I did my research and am following a diet/ lifestyle which I feel will prevent me as much as any can from having to go through that.

    Interesting point though, of my aunts and uncles some have decided against medicine and changed their diets with amazing results, some use the medicines and eat however they want.

    I agree that there are times when medicines are helpful but I feel that ALL pateints need to take some responsibility for their own health and choices. It's not always easy but it is doable.

    I really do wish Lillian and others in her position all the best. I just wish that they didn't feel surgery was their only option.

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  6. Agree with the last Anonymous comment; we are singing the same tune. It is the woman's TONE; her entitled, self-pitying attitude and the impression she leaves is that "If they won't give me what I want right now, it's their fault. I don't intend to do anything to improve my situation other than complain." Again, is that her true attitude? I don't know. But that's what comes across in her writing and in your support of her cause.

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  7. It comes down to "if you do not take care of yourself, weight control is not going to happen."

    The main stream advice will not help people with food addiction, insulin resistance, gross obesity. These need a lifestyle change, to low-carb, paleo, primal, hunter-gatherer or similar.

    Weight loss will come as a result. No sugars, grains, omega 6 oils, manufactured eatable products.

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  8. Anonymous9:57 am

    I felt the same way as many of your readers and the people who have already left comments. I felt that obesity was a choice, and that responsibility had been placed on everyone but themselves.

    Until I read this post by Dr. Arya Sharma, and it has changed my thinking:

    www.drsharma.ca/genetic-effect-on-obesity-increases-with-obesogenic-environment.html

    It goes with out saying, "Don't judge a (wo)man until you've walked a mile in their shoes"

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  9. Anonymous10:05 am

    "Medicine isn't about blame"...Talk about hitting the nail on the head.
    Regardless of the writer's tone in her obituary, the fact remains that there is an unacceptable wait time for this life-saving surgery. Shouldn't that be the point that has everyone up in arms??

    Maybe a false obit wasn't the best way to get accross the point, but why should we be so quick to pass judgement on this woman, who has obviously been seeking help (otherwise she wouldn't even be on the wait list)?
    We know nothing about her history and she is not obligated to share that with us. We do not help the obese by forcing our often ignorant opinions and judgements on them.
    Yes, obesity is preventable. We all know that. But it's here and we need to provide adequate treatment for the already obese and find a way to prevent obesity in the upcoming generations.

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  10. Anonymous10:37 am

    Norma, sorry, but your self righteous tone is precisely why people like Lillian feel they have NO alternative. Even faced with facts stated by Dr F, and COUNTLESS actual studies by respected doctors, you still hold steadfast to your indignation about the "whiny fat person" not doing what YOU think she should do. (which btw is based on NO medical actual proven fact). Never mind that your actual beliefs are bunk, and disproved as effective or actually work. You'd rather hold on to your superiority than to accept that you don't know squat about this issue other than to condemn those you clearly feel have character flaws.

    Let me ask:
    Do you run? Do you ski? Do you boat? Do you do impact exercise? Do you bicycle? Your kid skateboard? If we were to use your logic: Many of the injuries incurred by those activities are SELF inflicted, but still we patch up shin splints, broken bones for ski nuts who want to wizz down frozen snow at a 100 miles an hour. We patch up broken wrists of biker's, skateboarders, broken cheek bones from kids playing baseball, hockey, soccer etc etc etc....

    Norma, you're ILL informed and yet you continue to want everyone to dance to your tune, and advance your view of the world, no matter how damaging your advice actually is. Sad. And frankly quite revolting.

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  11. Anonymous10:38 am

    I thought it was brave of Lillian to write this. Sometimes you need to do something a bit more dramatic to get people talking about an important issue.

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  12. I am not self-righteous nor do I intend to come across that way. I have been obese. I have metabolic syndrome. I speak from experience. With the very limited information "Lillian" and Dr Freedhof offer about her specific medical history and weight history and her seeming complete lack of willingness to address her own issues but expect instant gratification from an overtaxed government health system, my opinion is that she does in fact need the surgery but her attention-getting ploy is a pitiful, selfish and immature approach. I'm not Canadian and the intricacies of socialized medicine are lost on me, but if there is no prioritizing people who need care (of any time) by the severity of their situations, that situation is not going to be helped by an "obituary." I found it very interesting that my friends who were required to get on a diet/exercise program before being eligible for gastric bypass were able to lose 50-70 lbs doing that when they had each insisted that diet /exercised didn't work for them their whole lives...once under a very strictly supervised program and in counseling to learn about their relationship with food, they were successful, had their surgeries (after waiting over a year) and have learned to control that relationship. Maybe Lillian has some options she can make a real effort toward while the wait goes on.

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  13. Anonymous11:22 am

    Norma, it can be quite the motivator when people are faced with the fact they must lose a certain amount of weight or they will not qualify for life-saving surgical intervention.
    I wonder how your two friends would have reacted/faired, in the long term, had they been told they had to wait 10 years?

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  14. First, I would like to thank Dr. Freedoff for posting Lillian's letter.
    I can't believe that Lillian's story would be received as negatively as it has been by some of your readers. I'm so shocked and saddened by their posts and opinions of Lillian. Can we live a day without someone's ideas of what they think we need to do to be healthy or happy? Just because some fad diet works temporarily for some, doesn't mean it will work for all.
    Lillian is not entitled, or self-pitying, or whiny. She hasn't given up.
    This is an attempt at an awakening of sort -- for people who discriminate against the morbidly obese, and our healthcare system that has failed us.
    I have been on a waiting list for WLS in Nova Scotia for over 12 years. I had to relocate to another province to be treated in a more timely manner, and that is unacceptable.
    Lillian wants to bring attention the issue of obesity to the forefront, and shame on all of you with your negative comments about her struggle and her journey.
    Norma, you come across so cold and so judgmental. Your words are harsh and cruel. If you claim that there was not enough information and details given about Lillian's journey, than how ignorant of you to form an opinion against her.
    I have had the pleasure to meet Lillian. Her decision to write an obituary was because of the lack of response from any other form of contact we have all tried over the years. It was for shock value, to pull on the heart strings of someone, ANYONE who could look into the wait times and help rectify the situation. Lillian did this for all of us WLS patients, pre-op and post-op, to have the health coverage we need for treatment and follow up.
    People have the right to their own opinions, but your opinion should be based on knowledge. You don't know her story, or her pain. You're seeing the end result of years of feeling neglected, abandoned, hopeless and mistreated by our own healthcare system that is supposed to help us.
    Shame on you really. Especially if you had your own struggles with weight loss.
    Believe me when I tell you, this is only the beginning. Lillian didn't write this obituary for a moment in the spotlight, for your criticism or anyone else's.
    Lillian wrote it out of sheer frustration to get someone to notice that morbidly obese people are suffering and being neglected by our health professionals. Our system is failing us.
    Lillian did this to act as a voice for all of us, all of us who have been pushed to the side while the Clinic here hand-chooses who they operate on and when. She wants to make a difference, to make the road a little easier for the all who follow her.
    You talk about your US friends who have had WLS and what they had to do to qualify. The same is for our residents. They have a pre-op diet with a set amount of weight they need to lose prior to surgery. There are group sessions, psychologist meetings, exercise, lifestyle changes, diet changes, nutritionists/dietitians. Waiting over 12 years for surgery, you can guarantee that we all know that the surgery isn't a fix-all. We've had lots of time to research how life will change and what changers are required of WLS patients.
    It's sickening to know that obesity is still the last socially acceptable form of discrimination. It's even more sickening to know that some of your readers, who have claimed to have weight issues of their own, can pass judgment on people brave enough to do something about this on their own.
    If you were morbidly obese, and took responsibility for your own life, how could you be so critical of someone facing the same struggles you faced only a short time ago. How could you have so quickly forgotten where you came from, what you have overcome, and how you felt at your worst?
    Thank you Lillian, for being brave enough to stand your ground and fight for all of us. I am so proud of you, and the courage you're showing to help yourself and all of us.

    ~Carly

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  15. It's not true that "even in the US", you have to wait a long time to get surgery. I live in the US and I got my surgery in 6 weeks. I could have had it sooner but it wasn't convenient to take off work until then. Of course, I had to pay for it myself, but waiting wouldn't have changed that as it just wasn't covered by my policy. One way to look at it is that at least it's paid for in Canada, but making people wait 10 years is essentially denying them access to medical treatment while pretending you aren't.

    And, Norma, you are absolutely missing the point of this article when you say that you need to know all the particulars of this woman's obesity history if you aren't going to judge her harshly. The only thing you need to know is that she's obese and the best possible treatment for that condition is being withheld from her.

    Thinking that you have to know how much she's suffered and for how long is playing the blame game and implying that only "deserving" people should get surgery. Not to mention, by the time the vast majority of people get desperate enough to chose surgery, they have tried and failed to lose their weight and keep it off many times. So why assume that this woman is any different?

    We know that diet & exercise alone does not work the vast majority of the time when significant amounts of weight need to be lost -- most people don't get to goal and, if they do, don't keep the weight off for more than 2-5 years. We even know the science behind why this happens. Yet people continue to insist that people are obese because they aren't taking personal responsibility.

    In my book, figuring out that there is absolutely no reason why that diet is going to work this time when it didn't work all the other times and deciding to pursue the only effective and durable cure for obesity *is* taking personal responsibility.

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  16. Anonymous12:41 pm

    This is one reason why Canada's public health insurance system is expensive, always getting more expensive, and will become unsustainable.
    It's like having a fire insurance company with no prohibition against arson - the insurance has to pay, even if you burn down your own house.

    Yes, there is sentiment that smokers don't deserve treatment if they continue to smoke. Doctors treat drunk drivers and non seat belt wearers - but society has police to ticket or arrest them. I have been reprimanded by strangers because my teenagers weren't wearing helmets for a recreational skate - imagine if they had a fall!. Expensive!!
    Obesity is definitely not the only condition where the patients get subtle or overt criticism along the lines of "this is your own fault. You should not have gotten into this mess, and I am mad that my taxes are paying for your medical care when your condition was preventable."

    Doctors may have to treat everybody (they'd treat an injured criminal as well as his victim), but we have a right to expect people to not drive drunk, not smoke, wear seatbelts, wear bicycle helmets, get childhood vaccinations, - and avoid becoming overweight, much less obese. It's just one of those trade-offs of being in a nanny state - yes, you get medical care, but, yes, the rest of us are going to be pissed off about paying for that care when the problem could have been avoided.

    As for whether 1 bariatric surgery is cheaper than years of treatment - that's for the accountants to decide.
    That's another issue - the allocation of health care by financial considerations.

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  17. Anonymous12:49 pm

    Thank you for running this blog for me Dr. Freedhoff you are an amazing writer and I appreciate you showing the bigger picture. I would like to first off say it was not meant as a poor me pity trip as some seem to think. It was to bring awareness to obesity and surgery times in Canada for weight loss and after care . To answer your question, I do have asthma, high blood pressure and sleep apnea and will be getting retested for diabetes that runs in both sides of my family. I am 42 yrs old, I weight 372 lbs down from almost 400 lbs. I quit smoking, drinking Pepsi and caffeine cold turkey over 2 1/2 yrs ago. My asthma was so bad at one point just over 2 yrs ago that I could not go from one room to another without my puffer and I had no stop lung infections and pneumonia back to back for almost a year. That is when the decision was made, I needed to change my life and start living toward a healthy me or die. All my life I was criticized and bulled for being fat and obese so all your negative comments are no different from all the hateful mean ones I have endured for 42 years. Yes as a baby I was on a diet, as a teen at the IWK and even tried a bunch of fad diets over my adult life. I am not ashamed of who I am, I am ashamed that people are still so ignorant, rude and negative about weight loss and the helpful tool the surgery provides.

    Yours truly
    Lillian

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  18. Shannon Bouchie2:29 pm

    Norma, and others who figure they know all about WLS by living vicariously through a 'fat friend' its sad that you will never understand the complexity of the issue for individuals who are obese. The sheer elation of losing 20lbs on your current diet, thinking that maybe THIS one will work... to the bone crushing depression that you failed.... AGAIN.... NOBODY is saying that lifestyle changes aren't necessary, however, when you're sick, have sore joints, sleep apnea, diabetes, to name a few co-morbidities, you're just trying to get through your day without falling down. Its NOT the same as needing to lose a few lbs, the physiology is completely different. There are lots of medical interventions that assist people in living a more normal life, I can't imagine why obesity is considered differently. I sincerely hope you never have to suffer the pain, the weakness, and the discrimination that plagues the morbidly obese, and that it is due to your lack of information that you would vehemently defend your position on this blog.

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  19. Thank you Lillian. Your post is a story seen over and over again. You were very brave to post your obit and your details. Thank you for standing up to bullies and for fighting for WLS in NS.

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  20. Katherine B2:56 pm

    Dr. Freedhoff, you are absolutely right. Medicine and health care are about compassion, a quality many of the commenters appear to lack. The sheer number of anonymous posters on here is very telling.

    Lillian, I think you are incredibly brave to put yourself out there this way. I had no idea the wait list was 10 years; that is outrageous! Keep spreading the word. It is definitely an uphill battle, given society's unfair and unfounded beliefs re: obesity and WLS. Keep fighting for it; you have a right to life-saving surgery. I wish you all the best.

    "A human being is a part of the whole called by us universe, a part limited in time and space. He experiences himself, his thoughts and feeling as something separated from the rest, a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from this prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty."
    --Albert Einstein
    http://en.wikiquote.org/wiki/Compassion

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  21. Anonymous3:39 pm

    I am sorry for the woman who feels utterly trapped by her situation, but my sympathy is compromised by a few things:

    1. I'm an American, and a lot of us could wait until the cows came home (or until we dropped dead) and nobody would ever cover our medical bills. We're uninsured. If we get lung cancer, we die. If we want bariatric surgery, we take out a loan or get a second job or find some way to scrounge medical coverage.

    2. Bariatric surgery is not a silver bullet. It just forces you to eat less solid food at one sitting. You can still torpedo yourself with milkshakes and ice cream and other rapidly-digested foods. Nor does bariatric surgery make you exercise. Try out the post-surgery eating and exercise regime and see what happens.

    3. My father has been fighting prostate cancer for five years and was told in April he has six months to live. When I look at how hard he's fought and how much he's gone through, including fasting for three days (zero calories) before chemotherapy every two weeks for a year, I just can't understand the attitude expressed in the obituary. And I am desperately jealous of anyone who has any condition that is at any level within their control.

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  22. Anonymous6:50 pm

    I suspect Norma's "weight issue" might be those vanity 15 pounds. THOSE are losable via exercise because what the body is doing to hold on to those pounds is VASTLY different than those who's body simply refuses to turn of the "gaining" switch. Live like that for 20 years and it's easy to see why people's bodies end up 100+ pounds over weight. Their body is the problem. NOT what goes in their bloody mouths.

    I paid 20k to have my surgery in Montreal, because I refused to be offered a substandard version of the surgery in Ontario... or have to jump through unnecessary hoops (such as meeting with a social worker. - WHY it's a social worker's business what IIIIII do to MYYYYYYYY body is absolute insanity.)... Nor was I going to wait for over 2 years. If I had a bundle of cash (won the lotto)... I would pay for Lillian's surgery.... and 9 more folks. Seriously.

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  23. Anonymous7:00 pm

    Norma said: I found it very interesting that my friends who were required to get on a diet/exercise program before being eligible for gastric bypass were able to lose 50-70 lbs doing that when they had each insisted that diet /exercised didn't work for them their whole lives.

    Geeze! IT's not the loss of weight that is the problem. It's MAINTAINING IT! The body will actually work against you and actually start to gain weight whilst only eating 700 calories a day. I suggest YOU try living on that amount of food and when you start gaining weight, see how well YOU do. You're trying to color your contempt of "fat people's" failings but it's still shining through despite your instances to the contrary. Please get PROPERLY educated what the body actually DOES to contribute to obesity issues and why people gain weight. Will power and bad character have NOTHING to do with it.

    People in Ontario have to to wait upwards to 2 and a half years. In that time, people can lose limbs, (feet, legs etc). I can't even imagine what a 10 year wait would do to people. Is THAT proper health care? Should they just BE mature about that wait? Should they just be mature about knowing that the loss of their limb could have been prevented had the system we PAY enormously for, via taxes, has abandoned them? My comment is absolutely NOT. THEY should be trying to embarrass the govt as often as they can and scream it daily from the roof tops. I say the same thing for hip replacements, hernia repairs etc etc etc. Our system is a mess. I think the time to be mature about it is about 20 years over due in Canada. Politicians have been using this damn system as a scare tactic to gain votes for decades.

    We import people from all over the globe and give them gold standard health care, but will leave our own flapping in the wind. Oh wait,... fat people hatred is still ALLOWED in this society - the politicians KNOW they won't get spanked for pushing our issues off the medical table.

    You know... Sadly , no matter how those who are the medically rationed put forth their message, there will always be people who know absolutely NOTHING about the realities of obesity yet who will stand on their soap boxes and venomously scream back: Screw you... go on a diet! Shame.

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  24. Anonymous American:

    I am sorry your dad has been diagnosed with 6 months to live. It is also very saddening that there is a lack of health care for the uninsured in the states.

    I don't think Lillian or anyone else for that matter is saying that lack of WLS is THE most horrible situation on the earth. But alternatively, it is something that needs to be addressed. People's lives are on the line, it is real and they are worthy of help.

    I think most of us understand that it is not perfect and it doesn't have a 100% effectiveness rate. But it beats 5% by a long shot.

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  25. Anonymous12:08 am

    To Lillian, and any other Canadians in her situation: (I am in BC, no 10 year wait, realistically NEVER for us)
    I want you to succeed with weight loss. I want you to have a healthy vibrant and long life. I want you to enjoy your loved ones! I understand how difficult it is for you (formerly 330#) to lose weight. I believe you need this life saving surgery, but life isn't 'fair' . If the existing medical system will not provide it for you, please take the steps necessary to get it outside of the Canadian medical system. You owe it to yourself to reach your full potential! Best f luck.

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  26. Maybe after working to loose weight for, God knows how many years and fighting for ten years to get a surgery, that I think her obituary was just her way to let off some steam. When you have tried everything to get something done and absolutely nothing is working, then the fastest way to solve the problem and as final resort, is to go to the media with something drastic (like in this case an obituary) Then the 'wheels of justice' or the government seem to amazingly turn fast. This is probably what the women was trying to do. Don't be so hard on her. You do not know what she has been through. After all in this country we are suppose to have a thing called "Health Care", but the word "Care" seems to most often go missing. WOW people, were is your CARE and compassion.

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  27. Anonymous4:19 am

    "Oh, you want surgical examples?"

    No, not if they're as wrong as the drug examples you gave. Asthma puffers are not proven effective, and have many side effects, ditto with anti-psychotics, which only sedate.

    Sorry to the woman for her wait. Surgeons will do what's most lucrative and least time consuming, hero making first.

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  28. Anonymous9:40 am

    No one chooses to be overweight. Why would anyone want to be obese? Don't you think that if they could do something about it, they would? It's not a matter of just pushing the plate away. Some people can diet and keep weight off. Others cannot control their food consumption. These people are not at fault, they have a disease called "compulsiver overeating". This disease cannot be cured, however, it can be arrested. I am a compulsive overeater and suffered with this disease for many years. I tried many diets and was successful. As soon as I lose my weight, I gained it all back plus more. Eventually, I was so addicted to food that I was gaining an average of 10 lbs/month. How long would it have taken for me to become morbidly obese? Not long at that rate. I was demoralized, ashamed, embarassed, lost all self esteem and just wanted to curl up and die. By the grace of God, I found a program that saved my life. This program is called Overeaters Anonymous. Overeaters Anonymous is patterned after the program of Alcoholics Anonymous. AA's are addicted to alcohol. OA's are addicted to food. There is no difference in the addiction except the drug of choice "food". Those who have never been addicted to food cannot possibly understand this killing disease. How could they? Who can understand alcoholism other than an alcoholic? There are many meetings available in Nova Scotia and throughout the world. This is not a diet club and there is no cost to attend. Please check out this website for more information. OA can save your life in more ways than one - I can attest to it. Together We Get Better. http://www.oa.org/

    Yes, surgery can help, but I have seen people who have had surgery nibble themselves back to being obese again. Then there are two problems - obesity and the inability to enjoy a good meal.

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