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Sleep Apnoea sufferer refused gastric band operation
An OSA sufferer from Stoke on Trent is taking his case to court after his local health authority refused him Gastric Band surgery, because he's not obese enough.
You can see his story here:http://www.bbc.co.uk/news/health-14084455
We know that OSA , left untreated, gives rise to other disorders. This poor man has severe Type 2 diabetes weighs 22 stones and has a BMI of 42; he's 62. As a diabetic, presumably he is on a strict diet, but that is not going to be enough. I don't know if he is taking his diabetes medication regularly (Metformin) to try to keep his blood-sugar in check, he doesn't say. He certainly needs to lose weight.
But the irony of the situation is that, with a BMI of 42, he is not big enough to justify Gastric Band surgery: no-one with a BMI of less than 50 qualifies, according to the PCT in North Staffordshire.
What is your opinion? Do you think the PCT should think again, or has this man neglected his health for many years and now puts the blame on the health service for refusing him the treatment he needs?
Is it the same scenario as the guy with bronchitis who smokes 20 a day? Does the health authority have the right to refuse treatment where there is evidence of abuse?
Views: 502
Replies to This Discussion
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Permalink Reply by Caveman on
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Sorry, got no sympathy here - I've always been big, topping out at 21 stones when my apnoea was diagnosed (the same doctor spotted type 2 diabetes also). If I behave and stop putting things in my mouth I lose weight - if I don't behave I end up suffering. It's simple enough - if you stop eating too much you WILL lose weight - I'm down to 17st and steadily dropping every month, my HBA1c is down to 8 (blood sugar long term indicator) and now regularly sleep for 6 to 7 hours straight. My blood pressure is now 120/70, which I'm told is not bad for a chap my size.
I'm dismayed when I think of what I must have cost the NHS so far just through being greedy.
Surgery is risky - surely summoning up a little will power is a small price to pay?
Just a tip - I tend to use the cardiologist's diet, it's nice and simple - if it tastes good, spit it out........
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I'll put an opinion into this one.
Losing weight is a nightmare and it isn't just about self discipline. However, whether being overweight is fair for people who"hardly eat a thing"; who "have glandular imbalance", who have "inherited genes which make you fat" or not; at the end of the day the only way to lose weight is to eat less. A gastric band may make this easier of course but there are still people out there who puree fish and chips and eat tubs of ice cream afer having gastric surgery because it can still "slip down"!
I have gone from 26 and a half stone to close to about18 and a half stone since going on cpap and I do attribute the weight loss to cpap but not because cpap is a cure as such. Cpap doesn't cure diabetes and doesn't remove floppy airways. It does help these conditions, in a roundabout way though and does help immensely to improve health and quality of life to the overweight person and everyone the overweight person affects (children; siblings; parents; friends; husbands and wives).
In my case, I was so exhausted (probably for years and years) that I had little self discipline. (When I was younger I had self discipline!!) I would start the day fired up to do the "right things" and behave sensibly with food. I would tell myself that there were people dying of hunger the world over and what was wrong with me that I was so pathetically weak willed!
I don't think many people without OSA truly understand how difficult it is to be sensible with food when your whole being cries out for somethikng to make you feel better; when you are so tired that you can hardly move. (Then of course the excess weight also makes it hard to move.) I was certainly disabled by the weight but as soon as I had my first night on cpap, I found that the dieting that I had been doing was working and my weight started to fall away.
I had found self discipline again. I not only started the day full of resolve but I ended the day almost as full of resolve. My BP is now good; my diabetes virtually non existent; my hypothyroidism neutral and my cholesterol good. I managed to cope with the gym after losing the first half of the weight and I did a body age assessment last year and came up as 9 years younger than my chronological age. I can do the cross trainer for 15 minutes now whereas at first I couldn't walk after pedalling it for 60 seconds!!
I felt like I was dying before and now I feel alive.
The pressure was on me to have a gastric band and I agreed because I thought it was the only way to survive. Then cpap came to the rescue (Darthvader is a friend?) and I was allowed to prove that I could do it without a gastric band.
I still need to lose weight but I'll get there in the end.
Don't assume that you have so much to lose that it is impossible to even know how or where to start. Just do it! Sleep first and then feel well enough to diet with courage and self forgiveness. Don't judge yourself for the past (there are enough folk out there doing that for you) and remember that you can't change what's gone. You can however, change the future.
As for this gentleman who thinks that the gastric band will put everything right for him; it might not but if it is the only way for him to lose weight, it may be a way for him to be less of a drain on society - if his diabetes doesn't result in amputations and other medical interventions aren't necessary. It is a gamble because many people don't change their lifestyle at all and just want it all to be given to them on a plate. If he is one of them, the gastric band won't save him but it is probably worth the gamble and maybe an exercise in damage limitation.
Rosemary Kemp
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Permalink Reply by Julie on
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Well Rosemary, thanks for sharing your experiences, sounds like you've been through the mill. If I’m ever needing any encouragement I’m coming directly to you….you sound great!!!!
I agree with most of what you say and well done for losing the weight....that is not easy to do. Unfortunately some people have a food addiction, just like any other addiction be it alcohol, drug, nicotine even those who exercise excessively to get that self induced high. I was a smoker around 5 years ago and I finally stopped after 22 years of smoking. It took me 20 attempts to do it but my health was suffering and I knew it. I am now a non smoker but personally can so sympathise with smokers who struggle to stop. Funny how the government are happy to tax smokers to the hilt but assist drug addict in any way possible when I believe that nicotine is more addictive than heroin. This poor guy is crying for help and should be given what he needs and if that is a gastric band then so be it. They should be taking all other health issues into account.
Unfortunately I am at the point where my doctor is telling me to lose weight as my blood sugar levels are rising and this is proving just as difficult as stopping smoking was. Unfortunately CPAP has not changed my life and I still have energy issues, in fact getting through each day is very difficult. I've always struggled with energy levels when some of my friends are bouncing about and never seem to tire. This was the case even when I was younger and slimmer. I remember many years ago going on a mammoth shopping trip for the day with friends and on the way home I was in the back of the car absolutely exhausted snoring my head off while my friends had a good giggle and that was when I was young fit and healthy. Now I have to think about where I'm going and what I'm doing to ensure I'm not driving when shattered and my concentration levels are low. I work full time and struggle on a daily basis as my concentration levels can sometime be dire. Thankfully I have an understanding employer and I just get on and do the best I can. On occasions I have an energy spurt...don't know where it comes from or why but that's when I try and get through the housework. Funnily enough I'm too shattered after work to go to the gym but on holiday I was hitting the gym for half an hour each day and loving it so I guess the moral of the story is stay at home, don't work and go to the gym.....if only LOL!!!!
Julie
Rosemary Kemp said:I'll put an opinion into this one.
Losing weight is a nightmare and it isn't just about self discipline. However, whether being overweight is fair for people who"hardly eat a thing"; who "have glandular imbalance", who have "inherited genes which make you fat" or not; at the end of the day the only way to lose weight is to eat less. A gastric band may make this easier of course but there are still people out there who puree fish and chips and eat tubs of ice cream afer having gastric surgery because it can still "slip down"!
I have gone from 26 and a half stone to close to about18 and a half stone since going on cpap and I do attribute the weight loss to cpap but not because cpap is a cure as such. Cpap doesn't cure diabetes and doesn't remove floppy airways. It does help these conditions, in a roundabout way though and does help immensely to improve health and quality of life to the overweight person and everyone the overweight person affects (children; siblings; parents; friends; husbands and wives).
In my case, I was so exhausted (probably for years and years) that I had little self discipline. (When I was younger I had self discipline!!) I would start the day fired up to do the "right things" and behave sensibly with food. I would tell myself that there were people dying of hunger the world over and what was wrong with me that I was so pathetically weak willed!
I don't think many people without OSA truly understand how difficult it is to be sensible with food when your whole being cries out for somethikng to make you feel better; when you are so tired that you can hardly move. (Then of course the excess weight also makes it hard to move.) I was certainly disabled by the weight but as soon as I had my first night on cpap, I found that the dieting that I had been doing was working and my weight started to fall away.
I had found self discipline again. I not only started the day full of resolve but I ended the day almost as full of resolve. My BP is now good; my diabetes virtually non existent; my hypothyroidism neutral and my cholesterol good. I managed to cope with the gym after losing the first half of the weight and I did a body age assessment last year and came up as 9 years younger than my chronological age. I can do the cross trainer for 15 minutes now whereas at first I couldn't walk after pedalling it for 60 seconds!!
I felt like I was dying before and now I feel alive.
The pressure was on me to have a gastric band and I agreed because I thought it was the only way to survive. Then cpap came to the rescue (Darthvader is a friend?) and I was allowed to prove that I could do it without a gastric band.
I still need to lose weight but I'll get there in the end.
Don't assume that you have so much to lose that it is impossible to even know how or where to start. Just do it! Sleep first and then feel well enough to diet with courage and self forgiveness. Don't judge yourself for the past (there are enough folk out there doing that for you) and remember that you can't change what's gone. You can however, change the future.
As for this gentleman who thinks that the gastric band will put everything right for him; it might not but if it is the only way for him to lose weight, it may be a way for him to be less of a drain on society - if his diabetes doesn't result in amputations and other medical interventions aren't necessary. It is a gamble because many people don't change their lifestyle at all and just want it all to be given to them on a plate. If he is one of them, the gastric band won't save him but it is probably worth the gamble and maybe an exercise in damage limitation.
Rosemary Kemp
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Hello Julie,
You are completely correct about the addiction thing. I also smoked and gave it up. I can not imagine how I smoked now, as I am so against smoking and smelly hair; clothes and breath etc. now (I do still take a deep breath when I go past someone smoking Gitanes!?) but we are strange lot. Eating is so different from alcohol addiction because we need food in order to live. If we could just never eat again I expect we'd adjust more easily. Alcoholics have to never touch a drop to stay clean. We still need to eat. It is often quite unbearable and feels so unfair.
I think that one secret is to keep loads of supplies of food that we allow ourselves to eat (thankfully I love fruit and vegetables) and a small stock of ultra dark chocolate for the anti oxidants and the chocolate yum! This has to be a treat though - a reward for being good. I also get filtered skimmed milk such as Cravendale (not meaning to plug a product but it is a fact that it is loads better than regular skimmed milk which I detest!)
I also have complex carbs and milk (including a shot of soya milk because it clears my conscience to have something that is supposed to help cholesterol levels) and not a yummy breakfast. Something like porridge. There are diet shakes out there but I don't want to make yet another plug. This tends to help me to survive a long working day and is good for the body's insulin levels. By not eating a yummy breakfast I also tend to not get the taste for food and seem to cope better over the day.
I do eat loads of fruit over the day though and take masses with me to work. It doesn't need to go in the fridge and I don't need to cook it (handling food always makes me want to eat!) I buy cans (with ring pulls) of mandarin segments in natural juice because they feel like a treat and they travel well.
Then I have also tried to eat loads of fish and cut right back on the chicken and meat but nothing is totally forbidden. There are a few restaurants where I survive better like carveries and Japanese restaurants where they do loads of grilled things. Tandoori and salad is also great in Indian restaurants. There's my diet in a nutshell. I hate calorie counting now because it makes me obsessive. It is necessary to change lifestyle and just ENJOY all the nice food we are allowed to eat. Guilt is a bad thing and it doesn't help us to deal with the addiction.
Sleep is terribly important. Go to bed earlier than you probably want to. Set up the cpap as comfortably as you can and just breathe deeply into it. The more you sleep the more the weight will drop. Also drink loads of water or low cal squash etc.. (Make sure you have a loo near to you).
I have found it so hard to work with this stuff going on but I have found it all so much easier now that I have lost weight. Continuing with the weight loss will always be a challenge and the doctors don't always say the most encouraging things. Some do and some just haven't got the gift of encouragement. It is probably the skinny doctors who have the least skill with this. They don't understand and just see us making ourselves ill. I suppose that if we were looking in from outer space we'd think that fat humans were mad and see it all in simplistic terms. (Assuming that we weren't fat aliens anyway!)
Go to bed when you start to feel hungry and don't think that you can bear it any more. In fact, go to bed before you feel that way because once you feel that hungry, you will visit the fridge first. Don't eat immediately before bed and preferably two hours before bed. Better for us for so many reasons - digesting the food before sleep is good; burning off some of the calories; better for us re the OSA and the breathing plus the fact that we don't have to rely on self control when we are really shattered.
Hope you have a good night's sleep tonight!
Rosemary
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Hey Rosemary, thanks for the advice. I'm off to bed right now so one piece of advice already taken LOL.
Thanks
Julie
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Permalink Reply by Tigers Fan on
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I'm not entirely surpised by Mr Clondiff losing his appeal. It can't be easy to agree on which cases should have the money thrown at them and which should not. It may be damage limitation to help people who request medical intervention but almost everyone has a cash flow crisis at the moment. I still believe strongly that the most important thing when it comes to weight loss is to help them to sleep first. My brain screamed out hunger when I was hugely sleep deprived. The other thing is to actually go to bed earlier and give ourselves a chance to get more sleep on the machine. (I am not always good at this myself!) We tend to stop eating once our heads hit the pillow! Rosemary
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If he is on disability or unemployment benefit, he would probably be able to get legal aid but I don't know whether lawyers would be prepared to take on a case like this (as a civil case rather than criminal) at the cost of the taxpayer. I suspect that the Appeal he went for wasn't through the law courts but through an NHS (hospital) complaints' procedure. If any one knows more about this perhaps they can answer you better. Rosemary
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Permalink Reply by Richard Mundy on
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Remember the OSA guy who was refused a gastric band because the PCT told him he was not obese enough to have one?
Apparently, common-sense has prevailed, the PCT have capitulated and he will soon have his op. No legal intervention has been necessary.
Let's hope the guy can now lose weight, and maybe even say good-bye to his OSA.
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Permalink Reply by Kath Hope on
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Thanks for the update Richard and pleased the guy's being helped now.
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And now he has to start the strict diet that he couldn't mangage before the op. Bariatric sugery is only part of the solution - unfortunately!
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Too right! Not only will he have an incredibly restricted diet but he will have a lot of pain for a while. It doesn't necessarily lead to the sleep apnoea disappearing either. I have lost over six stone now (as I keep on boasting about - such a show off) but I still have obstructive, central and mixed apnoeas. I may eventually be cured but it isn't very likely. Much better though. No question about that.
All surgery carries risk as well. If it saves the man's life and saves him and the tax payer from even more interventions to keep him well, then the damage limitation of the operation is worthy. I am just so relieved that I didn't have to go through yet more surgery. Being cut and operated on is no fun. Fast weight loss can also lead to bags of skin and infections under the skin so if you can do it any other way, I am sure that it is a good idea to try!!
Rosemary
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