Well,

I think our decision for the Lap Band procedure (self paying patients) as opposed to the Gastric Bypass procedure (OHIP covered) is now made.

We investigated both surgeries fully and without bias. We have friends who have used the Gastric Bypass and others who have done the Lap Band. Both have excellent stories of success over the long term and both have stories of difficulties.

Overall, the desire to have the cost-free version was strong but the 3-10 year wait list was wholly undesirable. In fact, I would say that if we were a full 100 pounds heavier than we are right now, my husband and I might have actually qualified for emergency surgery and a US destination hospital. Our co-morbidities are relatively non-existant so its off to the bank for us.

Anyway, Lap Band is the absolute winner now. Our Consultation is tonight and we expect that all will go swimmingly and our banding will take place in the next 30 days or so no matter where we choose to get the procedure done.

As for Canadians out there considering leaving home to get banded... I think you should re-consider whether you are self-pay or insured.

We did the math and here is how we saw things...

Cheapest is undoubtedly Tijuana, at least the procedure portion. Many of the clinics flooding the internet are from Tijuana, Mexico (usually just refer to themselves as a suburb of San Diego). You can really save thousands of dollars there if you are only considering the banding. Prices range from 5000 USD to 11000 USD and the market there is dominated by a handful of practitioners, some from the US and Canada. Problems we considered are as follows with absolutely no evidence, not even anecdotal, just our own 'WHAT IF' brainstorming.

- Hospitals and clinics have unknown standards

- Dr's claims to huge surgical numbers are unverifiable

- On returning home, complications may result in the removal of your expensive band by Canadian doctors using non-laproscopic methods.

- Free follow-ups require traveling to Mexico

- No liquid diets noted prior to surgery... does this not put the liver at risk?

- Unless you speak Spanish, are you sure you are safe?

The United States is the Most Available option for Canadians. There are many practioners all over the country and lots of financing companies willing to help you pay for the procedure. Consider the following...

- The US Dollar (at time of writing) is at a 20% premium to our Canadian Dollar which means that you will pay 20% more for everything from travel to lodgings for a few weeks in the host city to the procedure to medications purchased before returning home.

- The consultation we had in a good hospital in a good market gave us the cost of the procedure at 16000 USD but they did not provide any free follow-ups after the first year or fills ever. That means that should you decide to return for fills or adjustments you will again pay our in USD.

- Even if you decide to get it there and use the clinics up here to fill and follow-up... expect to keep paying and paying.

- Should you experience an emergency complication... you may again lose your band the hard way.

Finally, Canadian clinics... In our opinion are the Best Choice. For the following reasons and more...

- Your dollar is at par... hello!!! its our dollar and their dollar... doesn't change from day to day

- Since you will use a clinic close to you... the follow-ups and fills are probably free.

- Your band clinic will be contacted for emergency complications and I should hope that your banding doc would have something to say about the band's removal before it happens.

- If you have complications that only require a visit within 24-48 hours to your clinic... you can get there!

- Your costs outside of the procedure and some medications may only be a night in a local hotel once in a while depending on the distance you are from the clinic.

Well, I hope this information isn't too contradictory to anyone else's considerations. It is for these reasons and more that we will choose a clinic within a few hours drive from home in Ontario.

Any comments?????

Ok...I'll jump in and post to reply to some of your points. Some of what you said is very valid, other stuff not so much, altho please do not take any of this to be criticism on your thought process !!!

I am over 2 years post-op and have emailed, phoned and sat face to face with numerous bandsters who were banded all over the place. Some in Ontario (keep in mind I am in BC), some in Mexico and some like myself, in the US. Saying this is just to say that I have heard plenty of things, both good and bad, from all 3 of the possible surgery scenarios.

First of all....Mexico.

- Hospitals and clinics have unknown standards

True enough, altho I think by reading sites like this one, Obesityhelp.com and the many Yahoo groups available (I name these because it is where I did most of my early pre-band reading) you can learn a lot about different surgeons and clinics in Mexico. I have sat face to face with people in meetinns who went to Tijuana who have told me that they have ~never~ been in a cleaner or more organized facilty anywhere.

- Dr's claims to huge surgical numbers are unverifiable

Again, I agree, but I would never chose a surgeon that I had not read extensively about and spoken to some of his patients. By reading thru these sites you can easily pick out a few Mexican surgeons that it is easy to tell that they have numerous patients. As well, if you read things about certain surgeons (Dr. Ortiz immediately comes to mind) you will see that they are outstanding in this field and have in fact trained certain 'big-name' Drs both in Canada and the US. (by 'big-name' I mean well known in the bariatric surgery field)

- Free follow-ups require traveling to Mexico

Yes, however there are plenty of Canadian clinics who only offer short-term or limited 'free' aftercare.

- No liquid diets noted prior to surgery... does this not put the liver at risk?

I never had any pre-op diet to follow, liquid or otherwise. This is almost entirely dependant of your surgeon and varies greatly, the same as your immediate post-op diet will vary surgeon to surgeon. Another variable my be your health status at the time of surgery and how much weight you have to loose. My surgeon did not put me on a pre-op diet, but I know other people from the same clinic that were required to follow one. This said, there are 2 ladies in my support group who have just recently been banded by Dr. Ortiz in Mexico and they ~both~ were put on a pre-op diet. So Mexico is just like Canada and the US on this point, some require it, some don't.

- Unless you speak Spanish, are you sure you are safe?

Not at all. These clinics depend on their American and Canadian clients and all speak full English, all the way from the fellow driving the hospital 'taxi' (most clinics provide transportation from the airport to the clinics) to the surgeons.

And the US...

The US dollar issue is a given. If you manage to have surgery when our $ is good, then it can be good, if our $ is down, it's not so good. You will pay for your aftercare in USD which will fluctuate as the $ goes up and down.

- The consultation we had in a good hospital in a good market gave us the cost of the procedure at 16000 USD but they did not provide any free follow-ups after the first year or fills ever.

I paid 16000US and my clinic provided free fills for 13 months, free support for life and if I need to have any 'repair' surgery that will also be covered for life. I was happy with that and found it comparable to anything close to me and Canadian.

- Even if you decide to get it there and use the clinics up here to fill and follow-up... expect to keep paying and paying.

Agreed, but everyone needs to know what is included in their surgery regardless of where you have it done. Plenty of Canadian clinics don't offer free care and fills for your lifetime....so any of us can keep paying and paying.

And Canada....

- Since you will use a clinic close to you... the follow-ups and fills are probably free

As I said...this is only true ~if~ the clinic you choose offers free care. Everyone needs to be certain of what is included in the cost of your surgery and for how long.

- Your band clinic will be contacted for emergency complications and I should hope that your banding doc would have something to say about the band's removal before it happens.

Yes and no. I just spoke to a woman in Ontario recently who had some complications with her band and went to emergency at the local hospital. The attending Drs had no idea about 'bands' and were not willing to call her surgeon. They would not access her port to defill her. Her hysband finally took her home after having an IV to rehydrate her, and they called her band clinic once they got home.

It is pretty rare to have some kind of complication come up that will require ~immediate~ surgery and removal of your band. I would hazard to guess that in 99% of the cases you would personally be able to contact your surgeon regardless of where s/he is. The people that I know who have been banded in Mexico come home with the surgeons personal cell #, and a 24 hour emergency call #.

- If you have complications that only require a visit within 24-48 hours to your clinic... you can get there!

Agreed, and this is exactly why I chose the US and not Canada. This will depend on where you are located. There were 2 surgeons in Vancouver for me to choose from for my surgery and I decided that neither were a good fit for me. That left me to either drive to WA state or fly to Ontario. I decided that I wanted to be able to drive to see my surgeon and not worry about a plane ticket and trip across the country.

I personally think your post is great. It will give everyone something to think about when they are deciding what is best for themselves. You've pretty much done what I have suggested others do before surgery.....make a pro and con list and see what works best.

I'm glad you've decided to go ahead with banding....I honestly don't think you'll regret spending the money, it's an ~amazing~ journey !!!

All the best and good luck !!!!

Patricia

Nope my sentiments exactly. As a long distant patient, it costs me roughly $1,000 to travel to ONT. but I have the security of knowing a dollar is a dollar. I don't have to purchase travel and health insurance. As the band becomes more popular, fills doctors are available no matter where you had the surgery, but it is the unknown emergency that is the problem. Question one always has to ask.....can I afford to fly back to my clinic or should I stay closer to home. Another point, BC now has two doctors doing the band and I think all provinces (except Sask) now have doctors doing the surgery.

Personal choices are great for competition and keeps the prices down and as you said everyone has to do what they think is best for themselves.

Since I live in Ontario and had to make my pros and cons list 4 years ago about whether to stay in the province or go to Mexico or the US, I have to say, your list is almost identical to what mine was.

I didn't see any point in leaving the province when there were 2 very good clinics here. There are more than 2 clinics now but I only had 2 options back then. I am 6 hours away from the clinic, have had to be defilled a few times in an emergency and I went to the ER and demanded they defill me. The nurse gave me a hard time but I informed her it wasn't her call and that I would speak to the doc on call myself and he defilled me with me guiding him. Others have had problems getting defilled in an emergency but I stood my ground with them and they did it.

I have lifetime fills/defills at the clinic, I have lifetime follow up, I have a network of fill docs/nurses all over the country if I happen to be out of town, I have full use of their dietitian and wellness coach, I can speak to my surgeon whenever I need to, I have access to the emergency phone number 24/7 and the list goes on and on. I had no reason to leave Ontario other than the cheaper price and when I weighed it all out, the extra money spent to stay in Ontario was invaluable for peace of mind.

Best of luck with your decision on which clinic to go to. There are a few good ones in Ontario and perhaps you should do consultations with all of them since most offer free consults and you'll immediately know which one is best suited for you. I did a consultation with each of the 2 clinics and I knew immediately where I was going and have never looked back.

I have a slightly different perspective.. when I was banded I had US health insurance and could have had a lap RNY in less time and for free.... I couldn't be banded in the US since it was approved until much later in 02 than I was banded... but I could have self paid and gone to Mexico.

There were no clinics when I was banded and only two choices of local Toronto surgeons who worked together and both did my banding.

So even though I could have had a lap RNY faster I choose to self pay in Canada and a large part of that was the difference in the medical syste,.

I didn't trust Mexico at the time (this was over 7 years ago) and now that has been born out with the number of patients I have talked to who have no one to do their fills locally, who have had complications and their Mexican surgeon while very experienced in placing bands since he doesn't see most of his patients again isn't so skilled in complications... and sent them to find a new Dr in Canada. I have heard great things about the hospitals and the skills but crappy things about the follow up.

The US I know a little about the US since I work there much of the time... their medical system is a crap shoot.. so I get banded I pay for everything including fills in most cases. If you are fortunate enough to have Health insurance and have a WLS you better hope you keep your job and your carrier because if you switch jobs you new carrier can refuse you covered services because you had surgery under another carrier... even if you stay with the same carrier... and switch jobs they can refuse you coverage because it is a pre existing condition....

I am glad I made the decision I made 7 years ago, I could not have more confidence in my surgeon Dr Yau and my clinic and their support of me... I have had one issue with Slimband and it was resolved as soon as I complained... I agree with Tracey check out all the clinics and make your decision on who you are comfy with this is a long term relationship so you need to like who you are going to have it with.

Heather

It always amazes me, reading on here, how much people have to say about going to Mexico (or elsewhere) for surgery, when they have never been! I wouldn't comment on going to a Canadian or US facility, because I don't have any direct information to comment on. There is something to be said for getting direct experience with something before pronouncing such a strong opinion about it.

I had my surgery in Mexico by a dr. who has trained many of the surgeons who are now working in Canada and US. I considered surgery in Canada as well as US before ultimately settling on the surgeon I went to. I have worked in many hospitals (in Canada and US) and have never seen such a clean, well-run, professional, and efficient facility as I did in Tijuana. I was so impressed with the level of professionalism and expertise from everyone there and could not have imagined having a better experience anywhere else. I frankly trust my doctor more than I would trust surgeons here, because of his level of experience and expertise. Having said that, I wouldn't presume to comment on the expertise or experience of the doctors here (or in US, or in other clinics in Mexico) because I know nothing about them. I can't vouch for their own accountability and training for the procedure. I can't vouch for the number of patients they have seen or how many patients they would need to see before they are considered competent to do the procedure. And I can't vouch for the standards of hospitals or clinics here any more than I can vouch for them in Mexico. Do you know what those standards are? And do you know if those standards are actually being met? Even if you go to a facility in Canada or US, you still have to sign waivers to say the surgeon is not responsible if anything happens. I had to do that when I went for my first fill at a local hospital. And if anything does happen, suing a doctor for malpractice or getting restitution is not as simple as one might think.

At the end of the day, whether you go to Mexico, Canada, or US, you have to do your research. Look at the stats, evaluate how the patient coordinators respond to your questions, contact the manufacturers of the band, go to the support groups. And most importantly, talk to people who have been to those doctors. You will get the best information that way. All clinics will promote themselves, no matter where they are located, and hearing about experiences directly from people who have been there (not just hearsay and what you read on the internet) goes a long way to making an educated decision. And take it all with a grain of salt. People generally are going to support whatever doctor (or country) they have gone with, so talk to people who have been to different doctors.

With all due respect, Canadianchubbling, I was not impressed with the fear-mongering tone in your post, despite good intentions you may have had. Many people considering surgery are nervous, scared, and pretty much on their own. Their doctors likely know little to nothing about it, and people need to be supported in doing their own research and making their own decisions in a responsible, fact-finding way. And ultimately, supported in the decisions they choose. Don't assume people are ignorant and can't make their own decisions. You don't need to do their reasoning for them. Good for you for coming to your own (and obviously extensively-thought out) decision but allow people to make their own.

Edited January 18, 200917 yr by Vangirl

The reason the majority of us who are banded in Canada have reservations regarding Canadians going to Mexico is simple. Those of us on here have seen many people banded in Mexico promised aftercare in Canada. We then see these bandsters find the aftercare has fallen through and they are hoping one of the lap band clinics here will take them on. They come on the bandster boards regularly looking for help and asking for options.

I frankly don't care where a person gets banded but I hope they get in writing from a Mexican clinic what type of warranty they have for aftercare and for complications they can access here in Canada. A lap band is only as good as the aftercare needed for fills, etc.

I've read many pissy posts from people that are unhappy that the Canadian clinics won't do fills for them when they have been banded out of country and not just Mexico. Let's face it, all clinics are business and they have their own clientele so why should they provide a service to someone who opted to give their original business to someone else. If you buy a GM, do you expect to go to Ford to get your work done under warranty? I think not!!! I have nothing against anyone going out of country, that is their choice but when they constantly bitch that they can't get a fill from our Canadian doctors then I have zero sympathy. You made your choice,now live with it.

I really can't read into canadachubbling's post any fear mongering. I really think you have overreacted to someone who is excited and just wish to share their research. Your post has excellent points, but it is unfortuante you decided to add that heated comment.

I had problems with aftercare and find myself very fortunate that a Canadian doctor has taken me on but as the business grows most doctors will no longer take on other patients.

I too have read post after post of patients that have gone to Mexico and can't find aftercare. The bottom line is try to find a reputable clinic close to home. One you can drive to. For instance, in BC there are two doctors and a great clinic in Washington state. Hopefully people researching, will read the posts and make a decision accordingly.

All I know is what I have experienced... I have a friend who is an xray tech in San Deigo and based on the horror she personally has seen coming out of surgeries in Mexico she wasn't willing to go there and get banded... (her experience is surgerical not specifically banding but she has seen some people horribly disfigured, maimed where Plastics won't help and several die.)

I have talked to multiple patients who went to Mexico and thought it would be easier and cheaper. They are frustrated with the lack of fill sources available to them in Canada and several who have had complications and been left out in the cold by their Mexico surgeons and some of those have been surgeons who praises I have heard sung to the heavens...

I don't think it is fear mongering I think people should be informed if Mexico works for you then go, but don't expect me to be upset when no Canadian surgeon wants to fill you or help out with your aftercare that is your problem. I am with Tracey I have read a lot of posts bitching about people who can't get the aftercare they were promised so the deal they got in the end is not quite the deal they thought it would be.

If I was going out of country I would make sure I had a well written contract and I had proofed it with a Mexican lawyer because that contract means jack in Canadian courts and is not enforceable.

I made my choice to self pay and stay in Canada and I am happy with my choice and even knowing what I know now I wouldn't change that choice or clinic or surgeon. Dr Yau is the only surgeon I would want to have the surgery with.

Heather

I agree that my comments were heated (and this is the first time I have ever responded to a post in a heated manner, on any online forum). However, they were heated for a reason. It is one thing to share your own research and your own opinion, it is quite another to make point after point (many of which had questionable accuracy) with the purpose of directly discouraging others from deciding to go out of the country for their surgery. I feel this is inappropriate, and felt it necessary to say so. I am sorry, Canadianchubbling, if you felt that I was harsh on you, particularly if you meant it in good will. Unfortunately, I don't think many people realize what negative impact those kinds of statements have on the reader, as much as those statements may be made with good intention.

When I made my own decision to go to out of the country for my band, I had many of the same fears as others do here, but I did my research and came to my decision, and I do not believe this decision is any less valid or correct than the decisions made by those to go to a Canadian clinic. Whenever people have asked me about my experiences, I have always spoken highly and have recommended the place I went to. But I have never discouraged others from going to any place in particular, when I have had no direct experience of that place. I don't feel it is my place to do that. People will choose what is right for them, for their own circumstances, life, financial, or otherwise, and one person's circumstances do not necessarily apply to someone else's.

As to another comment made about not wanting to hear people banded in Mexico complain about their lack of aftercare, I would argue that any person who has been banded at a distance far away from a clinic would be in the same position. If you are living in northern BC, Newfoundland, northern Ontario, etc., you would have the same issues as you would going to any clinic that is not within easy distance of you. Many of us are fortunate that we live close enough to have a choice about going to a local clinic or not. Yes, it is a business, but business does not override ethics in providing emergency health care to individuals in an emergency. There is a lot I could say about that particular subject, but my basic point is that I felt the original post was inappropriate. That of course is my opinion, and others obviously disagree, which is fine.

Yes, it is a business, but business does not override ethics in providing emergency health care to individuals in an emergency. There is a lot I could say about that particular subject, but my basic point is that I felt the original post was inappropriate. That of course is my opinion, and others obviously disagree, which is fine.

I just want to clarify do you think that in an emerg situation (which life threatening band issues are rare very rare) you are thinking that you can go to a clinic and ask the surgeon to help you?

Now I can understand thinking that you can go to an emerg and ask the emerg docs to help you. But at emerg the odds of getting a band surgeon are somewhere between slim and completely never ever happening. The other consideration is from my limited understanding of the Cdn medical system and one of the reasons that most clinics won't take on patients is that once the band doctor sees you he has a moral and ethical responsibility to keep you as a patient. I know this was an issue I ran into post plastic surgery when I was in Calgary and my surgeon was in Toronto. The Calgary docs saw me in emerg but the answer I was given was basically go home to Toronto and have your surgeon help you we won't touch you we don't want to see you or help you get on a plane and get out of here.

I agree patients who are distance from their clinics have other considerations than those who are closer to their clinics but understand we all choose our clinics for a reason and most of us wouldn't make another choice.

Heather

susieq I certainly agree with your reasoning. When I got my band, as most newbies, I had fear for every creak and groan I was experiencing. Yes, as a long distance patient, I had difficulties with my clinic but that is water under the bridge now.

Would I pick the same clinic again, yes for the surgeon I would. However if I had the choice of a local doctor I would have gone locally, but at the time, he was not yet doing bands. I now go to Dr. W. every 3 or 4 months. But if I need any surgical intervention, I must return to my clinic and the fact I don't have to pay for the surgery is a godsend for me but I still have to come up with travel costs.

That is why I recommend check out your local surgeons first if you are not "flush" with money. With this economy who has security?

There are many people who are banded at The Surgical Weight Loss Centre and who live as far away as Newfoundland, Northwest Territories, Alberta, etc. Many have access to fills in their area provided by doctors or nurses trained personally by my surgeon Dr. Chris Cobourn so they are not necessarily in the same situation as those banded in Mexico at all.

It's one of the reasons why SWLC is so popular with patients wanting to be banded from across the country. As many of the posters above have replied we have been on several of these boards long enough to hear many people who are banded out of country who find themselves without appropriate aftercare. That's why we continue to advise caution and if people are banded elsewhere but have a contract providing support back in Canada then that's great.

I just want to clarify do you think that in an emerg situation (which life threatening band issues are rare very rare) you are thinking that you can go to a clinic and ask the surgeon to help you?

Now I can understand thinking that you can go to an emerg and ask the emerg docs to help you. But at emerg the odds of getting a band surgeon are somewhere between slim and completely never ever happening. The other consideration is from my limited understanding of the Cdn medical system and one of the reasons that most clinics won't take on patients is that once the band doctor sees you he has a moral and ethical responsibility to keep you as a patient. I know this was an issue I ran into post plastic surgery when I was in Calgary and my surgeon was in Toronto. The Calgary docs saw me in emerg but the answer I was given was basically go home to Toronto and have your surgeon help you we won't touch you we don't want to see you or help you get on a plane and get out of here.

I agree patients who are distance from their clinics have other considerations than those who are closer to their clinics but understand we all choose our clinics for a reason and most of us wouldn't make another choice.

Heather

Access to health care is an important issue, and I would suggest checking out the ethical guidelines for the Canadian Medical Association and the College of Physicians and Surgeons in your province. These guidelines address the ethical obligation of a physician to treat a patient in life-threatening circumstances. I think it is a good idea to be informed of these, in any circumstance, banded or not.

Not to shy away from the discussion, but my purpose in responding to this thread was to express my honest feelings about the original post, which I felt needed to be heard, as well as my reasons for those feelings. It is pointless to drag on a debate, since it would just be a repetition of the same, and there are still going to be differences of opinion anyway.

Doctors do have to treat us in a life threatening situation but who is to say you are going to see a band surgeon when your life is threatened? And exactly what life threatening situation could you be in with a band. There have been patients who went to the ER in tons of pain and the only thing they could get done was have their band removed totally and not by a band surgeon, by whoever the surgeon on call was. Since the clinics are private, it's not like you just walk in their door with your provincial health coverage and get care, that's not how private clinics work. If you are lucky, you could end up in an ER where a banding surgeon still does ER duty but my bet would be his only obligation would be to stop the pain which would result in removing your band. I know that if I end up with a problem and my band is removed for medical purposes, that my band surgeon will replace it at no cost to me. Some clinics do not have the same policy. I am a long distance patient but have no problems at all. I needed a fluoro and I returned to Mississauga and had it done with my surgeon. I got too tight for no reason and I got a defill by the fill nurse locally. I have all my ducks in a row for my follow up even though I live a distance away and I also know that I'm only a plane ride away from my surgeon and I know he will meet me at any hour that I arrive if I'm in an emergency situation.

We all do our reserch and the original poster obviously did theirs and they listed their reasons to stay in Ontario vs going out of country. They are her reasons to stay here and there was no fear mongering in any of what she wrote. They are her observations and her conclusions. Nobody is saying don't go out of country, she is simply stating why she didn't. For anyone that lives in Ontario, I don't see any reason to go out of country at all. We all end up having to fly to Toronto to fly to any city in the US or Mexico so it's just as easy to get off the plane there and be done with it.