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Hello!

This is my first time posting, I have been lurking for a while. I hope I am posing in the correct section!!

I am from Canada, and was referred to the Bariatric Program in my city. I know that the USA and Canadian programs are similar in terms of requiring time with a dietitian, psychologist, internal medicine doctor etc.

In April, I was booked for my first class in June. As a smoker (now ex-smoker!) I planned to (and quit) a few days before the orientation class. In the orientation class, immediately we are informed that being in the program or class isn't a guarantee of surgery (which is completely acceptable!), it is posted everywhere, and we are reminded of it pretty much all the time. I had an appointment with the Nurse case manager in August. She was great. In each appointment, you book your next appointment with another discipline you need to see throughout the program. I was then booked for a nutrition basics class for the end of August, then with the dietitian in September.

The nutrition class I didn't find particularly useful (personally), as the things that we covered, I was already practicing. I was excited that the dietitian wasn't the type to roll in there and tell everyone they had to eat a certain diet. In the class (there was about 20-25 attending) she had said that they started doing the nutrition basics class because they felt that they often had to go over basics with so many people...they thought one class for everyone for the basics, and then when you meet with your dietitian, it is more individualized, and targeted to your needs. I was very excited about this, and it turned out the dietitian that was teaching the class, was who I was booked with in September.

Then I rolled into the appointment in September (the day before my vacation - a cruise) for my first appointment with the RD. I feel like we immediately started off on the wrong foot. I had blood tests done (as requested) and I don't think she liked them. Everything on the blood tests were fine. Whenever I get tested for my white blood cells they come back 'slightly high', and it's been like that for years and I chalk it up to obesity, knee arthritis and the steroids I take for asthma. My family doctor is not concerned. The other thing was my triglycerides were boderline high (the rest of my cholesterol is good), and I have spoken with my doc about that and he is not concerned.

She didn't seem to like that I wasn't running to my doctor about my white blood cell count. I felt like she was snippy about the triglycerides, even though my doc wasn't concerned. She looked at my food tracking (every day religiously for 6 weeks), and looked at one day. I eat 1 banana and 1 apple everyday during the work week. She started telling me about substituting berries instead of a banana. She also suggested that I walk around the buffet a few times on the cruise ship before deciding what to eat. When she asked how much wine I was going to drink on vacation (I stopped all alcohol for over a month at this point), and I said "Maybe 1 glass per day at dinner...?" that was the WRONG answer...and told me to try again. So I said...I guess 1 glass every 3 days....? Then she suggested I use smaller plates to cut my portion sizes.

I left there...and my poor husband...I came home in a flurry of tears, and frustration. I didn't ask how to reduce my portions on vacation...I already know how to do that. I didn't ask her to help with with my cholesterol, I have a doctor for that. She wanted to know why I was taking Omega 3 ...and seemed skeptical of my answer that most people don't get enough, so I figure it would help to take some. I am still so discouraged by this.

A few weeks ago I went to the psychologist. There was a questionnaire I had to fill out (essentially about being compliant after surgery). I told him I struggle with exercise now because of my knees...so he suggested yoga. Really? I am obese, with painful knees....if I have a hard time on the treadmill or on the elliptical, why would kneeling on the floor help...? Oh. because you do Yoga. Noted. I tried to create some discourse: The link to obesity and sleep is something I notice...I started to tell him I notice my appetite increases if I haven't slept well because it's like I need to stimulate myself to stay awake. And that turned into getting tested for sleep apnea. I don't have sleep apnea. He mentioned smaller plates to me again (it just seems out of context)

So I am feeling like because I am not a total trainwreck, they don't know what to do with me. I totally get that people need more help than 'read a label', but I feel like I have spent a lot of time researching diets, weight loss, obesity etc etc for the better part of 10 or 15 years...and they have not taken the time to find out what I do know. I feel like if I say certain trigger words like 'tired' = Sleep apnea! Wine = Alcoholic! So I don't know what I am supposed to be doing.

I feel like I don't know what they want from me. If they want me to lose weight, then I want them to say it. If they want me to stop this or start that, then say it, and have a purpose. I have read all sort of literature about WLS and Set points etc etc and when I go to these appointments I don't want to walk away feeling like they think I am obese because I opted for a banana instead of blueberries (hate them) all these years. I want to get more out of this, but I am also very tempted to just try and tune it out and tell them what they want to hear so I can get the surgery. I am just a number, and I somehow have to fit in their flow chart...not the other way around.

Does anyone have any advice? I just feel super discouraged and criticized and not looking forward to another year of appointments every month feeling this way.

Thanks for your help!

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Just keep doing What you're doing I had a dietitian try to tell me things I already knew because like you I've been researching this surgery for a year now :)

I'mglad in Australia we don't need to jump through those hoops for surgery all it takes is a letter from surgeon...

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Hi, Canadian--and welcome to the forum as a poster!

There is a lot to unpack in your message, but let me start by saying I completely understand the frustration you are feeling. I had thoroughly researched WLS before ever contacting a doctor, so I knew the pros and cons of both sleeve and bypass and fully understood what was involved, both pre- and post-surgery. I also found the nutrition class way too basic, because I already knew everything they covered based on my research. I just viewed it as a box I had to check and suffered through it.

Unfortunately, I think you and I are unique as very well-informed patients. I was truly shocked at how many people in my nutrition class were clueless about what to expect from surgery and especially how they need to dramatically alter their eating habits, both before and after. I think the nutritionist needs to begin at a very basic level to ensure that everyone gets the necessary information to make an informed decision.

As for your doctor, it seems that he/she wants to be incredibly thorough in addressing all possible medical conditions that could be an issue with your surgery. In addition, there may be professional liability issues that require your doctor to look at every possible issue before approving surgery. I also had a huge battery of tests, including a sleep study, that I didn't consider necessary--but once again, the box needed to be checked so I went along. My surgeon also suggested that I follow up with my primary care physician on my high BP, cholesterol, liver enzymes, etc. (although in a polite and supportive way). However, my doctor was already aware of all of those issues and we were dealing with them, so I saw no need to see him again (although I didn't tell my surgeon that). Your surgeon is probably reiterating Portion Control and foods to avoid because so many patients need to be reminded constantly. However, there's no excuse for being rude and dismissive.

One question: What is your BMI and how much weight are you hoping to lose? Perhaps your surgeon is not sure whether weight loss surgery is appropriate for you. (I was on the cusp, with a BMI of 37, but my surgeon was very supportive of my decision to pursue surgery and never questioned my motivation.)

As for the psychologist, he seems completely out of his lane. My understanding is that the psychological assessment is for the sole purpose of ensuring that you understand what is involved in WLS and that you are prepared to commit to a long-term change in your lifestyle. I would simply ignore the rest of what he said. Hopefully you don't have to see him again.

So, all of that said: i think it's essential that you feel comfortable with your surgeon and nutritionist. You should be able to discuss your issues with them candidly and trust that you will get an accurate, informative and supportive response. If you are already reluctant to raise certain issues with them because of how they might respond and are worried that they are not providing the information you need, then you might want to consider looking elsewhere (if that is possible). It could mean you can't have surgery as soon as you might like, but I think it would be worth it in the long run. You will have a long relationship with your surgeon, and you need to feel certain that he/she sees you as a person, really listens to your concerns, and fully supports your choices.

Edited by Recidivist

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Tell these cogs what they want to hear so you can move things along. Believe me, they are pathetic nobodies in the big picture.

I hate that these ego-starved "professionals" are dragging you down, and making you feel unsure of yourself.

Trust your own better judgment and remind yourself that you know you and they don't! Get a good raincoat and let everything they say roll off of you. Feed yourself a daily dose of positive affirmations (no matter how corny) to counteract their barbs.

You sound like a sensible and centered person. Don't let others make you feel less about yourself or your goals. And keep coming here. Vent, vent, vent.

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I have a pretty ruthless dietitian. He tells me to stop eating or drinking a certain item all the time. I've been scolded for eating a banana as well. Lol. But I try not to take it personally or see it as a stab at me but rather an aggressive coach in my corner who wants me to succeed as much as i do. After all if i could have done this all on my own, I wouldn't have needed surgery in the first place. As for all the tests that come with, it wasn't my doctor that demanded all these hoops, it was the damn insurance companies. Like Recidivist above said, it's a box that needs to be checked.

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I’m sorry you are having this experience. Deciding to have WLS is not easy and you should expect your team to be supportive and encouraging. Everyone in this forum will tell you there is no one size fits all (no pun intended) in this process though I can see benefits in a general introduction to the basics of the process in a group class before your individual appointments.
Yes, in Australia it is different and each doctor has their own requirements. Mine requires his patients to visit a dietician before surgery and regularly for at least 12 months post surgery. A much younger friend went to a different doctor and only had to see a dietician once. She is struggling post surgery with her food, trying to take the easy route of takeaways and frozen meals & wonders why she is in pain & vomits a lot. My doctor also recommends therapy but considers each patient’s weight gain/loss history & personal history before making the recommendation. He said I didn’t need to but provided a list of therapists I could see if i wanted pre or post surgery.
My dietician isn’t very good but better than the one I went to years ago who told me I didn’t eat enough. Consequently I put on weight seeing that one - thanks a lot. This one asks what I eat (I just tell her my basic menu), what I weigh and that’s it. Five minutes & I’m gone. No information about calories, macros,... I rely on my own research ( God bless google & this forum) and a friend who had the surgery 12 months before me.
Be patient, keep calm, breathe deeply when attending meetings with your team and follow the steps. Keep up your own research & this forum. Don’t let your frustration with this pre surgery process hinder your surgery. You won’t regret it. Good luck.

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I will tell you what I tell my kids....You are responsible for how you allow people to treat you...you can't stop their words or attitude but how you respond and how you let it effect you you can control. When people are on a power high, because be honest they have all the control at this point in time, they can be horrible. So kill them with kindness..... Thank you so much I will try that, Im so glad you suggested that I would have never thought of that, do you have anymore suggestions so far they have all be so helpful, so now you get the idea of what to say. People are only bullish to get control, so just give it to them why fight it. They are just a snapshot in this weight loss journey. Once it's over you have all the power and in the end it's your discussions. Deep breath dry those tears and enjoy your vacation !!!!

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3 hours ago, canadianpopcycle said:

Hello!

This is my first time posting, I have been lurking for a while. I hope I am posing in the correct section!!

I am from Canada, and was referred to the Bariatric Program in my city. I know that the USA and Canadian programs are similar in terms of requiring time with a dietitian, psychologist, internal medicine doctor etc.

In April, I was booked for my first class in June. As a smoker (now ex-smoker!) I planned to (and quit) a few days before the orientation class. In the orientation class, immediately we are informed that being in the program or class isn't a guarantee of surgery (which is completely acceptable!), it is posted everywhere, and we are reminded of it pretty much all the time. I had an appointment with the Nurse case manager in August. She was great. In each appointment, you book your next appointment with another discipline you need to see throughout the program. I was then booked for a nutrition basics class for the end of August, then with the dietitian in September.

The nutrition class I didn't find particularly useful (personally), as the things that we covered, I was already practicing. I was excited that the dietitian wasn't the type to roll in there and tell everyone they had to eat a certain diet. In the class (there was about 20-25 attending) she had said that they started doing the nutrition basics class because they felt that they often had to go over basics with so many people...they thought one class for everyone for the basics, and then when you meet with your dietitian, it is more individualized, and targeted to your needs. I was very excited about this, and it turned out the dietitian that was teaching the class, was who I was booked with in September.

Then I rolled into the appointment in September (the day before my vacation - a cruise) for my first appointment with the RD. I feel like we immediately started off on the wrong foot. I had blood tests done (as requested) and I don't think she liked them. Everything on the blood tests were fine. Whenever I get tested for my white blood cells they come back 'slightly high', and it's been like that for years and I chalk it up to obesity, knee arthritis and the steroids I take for asthma. My family doctor is not concerned. The other thing was my triglycerides were boderline high (the rest of my cholesterol is good), and I have spoken with my doc about that and he is not concerned.

She didn't seem to like that I wasn't running to my doctor about my white blood cell count. I felt like she was snippy about the triglycerides, even though my doc wasn't concerned. She looked at my food tracking (every day religiously for 6 weeks), and looked at one day. I eat 1 banana and 1 apple everyday during the work week. She started telling me about substituting berries instead of a banana. She also suggested that I walk around the buffet a few times on the cruise ship before deciding what to eat. When she asked how much wine I was going to drink on vacation (I stopped all alcohol for over a month at this point), and I said "Maybe 1 glass per day at dinner...?" that was the WRONG answer...and told me to try again. So I said...I guess 1 glass every 3 days....? Then she suggested I use smaller plates to cut my portion sizes.

I left there...and my poor husband...I came home in a flurry of tears, and frustration. I didn't ask how to reduce my portions on vacation...I already know how to do that. I didn't ask her to help with with my cholesterol, I have a doctor for that. She wanted to know why I was taking Omega 3 ...and seemed skeptical of my answer that most people don't get enough, so I figure it would help to take some. I am still so discouraged by this.

A few weeks ago I went to the psychologist. There was a questionnaire I had to fill out (essentially about being compliant after surgery). I told him I struggle with exercise now because of my knees...so he suggested yoga. Really? I am obese, with painful knees....if I have a hard time on the treadmill or on the elliptical, why would kneeling on the floor help...? Oh. because you do Yoga. Noted. I tried to create some discourse: The link to obesity and sleep is something I notice...I started to tell him I notice my appetite increases if I haven't slept well because it's like I need to stimulate myself to stay awake. And that turned into getting tested for sleep apnea. I don't have sleep apnea. He mentioned smaller plates to me again (it just seems out of context)

So I am feeling like because I am not a total trainwreck, they don't know what to do with me. I totally get that people need more help than 'read a label', but I feel like I have spent a lot of time researching diets, weight loss, obesity etc etc for the better part of 10 or 15 years...and they have not taken the time to find out what I do know. I feel like if I say certain trigger words like 'tired' = Sleep apnea! Wine = Alcoholic! So I don't know what I am supposed to be doing.

I feel like I don't know what they want from me. If they want me to lose weight, then I want them to say it. If they want me to stop this or start that, then say it, and have a purpose. I have read all sort of literature about WLS and Set points etc etc and when I go to these appointments I don't want to walk away feeling like they think I am obese because I opted for a banana instead of blueberries (hate them) all these years. I want to get more out of this, but I am also very tempted to just try and tune it out and tell them what they want to hear so I can get the surgery. I am just a number, and I somehow have to fit in their flow chart...not the other way around.

Does anyone have any advice? I just feel super discouraged and criticized and not looking forward to another year of appointments every month feeling this way.

Thanks for your help!

Can you find a new team?

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I'm not sure if you have the option, but can you ask for a different team? You'll have a long-term relationship with them, at least in the US, you have to meet with the surgeon every year, forever. I don't know what will happen to that if you move or something and can't see him or her.

The dietician and surgeon and psychologist need to "check boxes" and they're used to meeting with people who don't have a clue, so you thank them for their advice and you move on. It's their loss that they don't take the time to figure out that you have a fund of knowledge already so that you can have a deeper relationship. Hopefully there will be someone on your journey who will appreciate that you've done your research and that you need a higher level of communication.

I hope that you are able to find the support that you need and want from someone in your team. And if not, keep coming here ... we're all here to support each other in our journeys.

Blessings.

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Thanks everyone for the insights you have provided!

Unfortunately, I don't think I can just get another team. Since this is covered by healthcare, the Bariatric Clinic was a waitlist. Through the Clinic it is a team of Dieticians, Psychologists, Nurses, an Internal Medicine Doc(s). I have not met a surgeon, and won't until I am 'approved' for surgery. I don't believe there are actual specialized bariatric surgeons in Canada (I could be wrong), but everyone I have looked up in my city and a few others are general surgeons that do bariatric surgeries. I believe this is mostly due to our publicly funded system. I have thought about talking to the Nurse Case Manager about switching some people around...but I think I will wait until I see them again....I see the dietitian in 3 weeks, and the psychologist again in 6 weeks.

I think this is where some of the intimidation factors come in. I cannot just 'throw my money around' and go somewhere else...Unless I wanted to fly to Mexico. If these people don't view me as compliant, and 'working the program', then I don't get surgery. If you miss any appointments, without proper notice, you are out. I get it...it's publicly funded...but I am also not really enjoying take time off for at least 2 appointments a month, and drive all over the city, and have them be dismissive and still possible not do what they want, and I don't get surgery.

My frustration has been that...and then I am not seeing some of the correlation between what will happen 'after' surgery. I feel like I am on a weight loss program, not on a program to determine if I am a candidate for surgery, and how successful I can be.

It's like the banana thing again: You are criticizing my fruit choice...I should have berries instead. The debate isn't between a double quarter pounder and a banana, it's literally a banana and berries! It just seems ridiculous. Or the 1/2 cup of haagen daaz I had one day (that I measured!!!!)...not really believing how much Protein was in it, because it was ice cream.

I guess I am just trying to regain control of the situation...and I don't like that I can't disagree with someone because they decide if I get surgery. That said, I can do my best to bite my lip if I need to. I just don't want to be so frustrated with them that I miss valuable information from them because they irritate me.

I believe someone asked earlier...but my BMI is quite high, so I am not on the cusp of eligibility.

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I mean 5 hours and u could be going to my drs??? They're really great. I went through 2 other practices before this one. Im in US. Some will tune you out and just keep telling you what their job requires you to.

Sent from my LM-Q710.FG using BariatricPal mobile app

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On 10/23/2019 at 8:25 PM, Arabesque said:

I’m sorry you are having this experience. Deciding to have WLS is not easy and you should expect your team to be supportive and encouraging. Everyone in this forum will tell you there is no one size fits all (no pun intended) in this process though I can see benefits in a general introduction to the basics of the process in a group class before your individual appointments.
Yes, in Australia it is different and each doctor has their own requirements. Mine requires his patients to visit a dietician before surgery and regularly for at least 12 months post surgery. A much younger friend went to a different doctor and only had to see a dietician once. She is struggling post surgery with her food, trying to take the easy route of takeaways and frozen meals & wonders why she is in pain & vomits a lot. My doctor also recommends therapy but considers each patient’s weight gain/loss history & personal history before making the recommendation. He said I didn’t need to but provided a list of therapists I could see if i wanted pre or post surgery.
My dietician isn’t very good but better than the one I went to years ago who told me I didn’t eat enough. Consequently I put on weight seeing that one - thanks a lot. This one asks what I eat (I just tell her my basic menu), what I weigh and that’s it. Five minutes & I’m gone. No information about calories, macros,... I rely on my own research ( God bless google & this forum) and a friend who had the surgery 12 months before me.
Be patient, keep calm, breathe deeply when attending meetings with your team and follow the steps. Keep up your own research & this forum. Don’t let your frustration with this pre surgery process hinder your surgery. You won’t regret it. Good luck.

Wow, seeing that you're from Queensland, triggered a memory of one my first penpals some 40 or so years ago. I can still remember her name (Christine Crump) and where she lived (Townsville).

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