Review of the first consultation

Hi guys!

This is a review of my first consultation with the physician at the Bariatric Clinic in room C59 at Khoo Teck Puat Hospital. Noting that I was super excited as this appointment was one month since the referral from Woodlands Polyclinic, I woke up early and did my morning exercise as per normal and unknowingly left my referral letter at home!

It was frustrating to realise it only when I had scanned my IC at the lobby of the hospital. Furthermore, with the recent Covid-19, there are additional pit stops to check on the history of travel background, medical condition and if they have been swabbed prior to the appointment.  This means you can only visit the individual clinic that you were assigned to, 30 mins prior to seeing a doctor. Upon registering with the front desk staff, I provided my identification card and informed them that my twin sister is on her way to provide me with the document. They went out of their way and reprinted the document for my doctor’s reference. 

Similarly, they informed me of the charges prior for the various tests but as I have completed most of it at the polyclinic, instead of paying $300+ consultation fee, I paid $60+ at the polyclinic and +$100 for the consultation that day. I had to do one ECG test to check on the pulse near my heart and veins near my feet and wrists. My results were great but my fat percentage level was 67% which means crucially, it’s a miracle that my body is fine as of now. 

While waiting for the physician to see me, I was observing the various patients and was indeed amazed at how regular-sized they are. Dr Ho Ching Yun was super approachable and simply started the consultation as though it was a coffee talk and wanted to understand why I wanted to lose weight and it was more of a goal oriented chat over generalised reasoning behind the weight loss desire such as better health, to look better or do more physical activity. 

This was where I shared with her how I wanted to do rock climbing and I wanted to go to Natura Vive Skylodge capsule suites in Peru and this was one of the travel bucket list that I wanted to strike off when I turn 30. 

Natura Vive in Peru

During the first consultation, the nurses shared about how the weight loss programme will approximately take 24-week (about six months) where patients are provided tailored advice so you can make lifestyle changes to help you succeed in your weight loss journey safely. 

Seeing how I was able to schedule for my next appointment only a month later, I will say that this whole process would be similar to adult learning. It will not be something spoonfed or where the doctor holds your hands throughout the programme, as a patient you will need to show the doctor that you will do your own part to lose weight.  Monthly or even bimonthly reviews are encouraged to enjoy the maximum benefits of this programme. 

The program comprises five phases:

Do note that phase three of the program is flexible, comprising a range of sessions that can be selected to cater to each individual’s unique needs. The doctor also shared about the non-surgical options or the surgical options to lose weight and will discuss with you what is the best options to lose weight and understand a little bit more about the efforts that you have put in to lose weight. As I previously lost about 30kg in 2015 and this is considered a rebound weight gain, she shared that the surgical option is recommended for me. 

Similarly during the consultation, I have shared about my efforts to maintain a calorie deficit and how my knees wobble when doing cardio activities. She shared about the non-surgical options which are exercise-diet or dietary supplements like phentermine and calorie deficit diet. Currently the supplements are pretty tempting but the cost of the various medications cannot be paid through medisave and has side effects. Truth to be told, the medication can be purchased externally so that’s definitely not my preferred method. They have a new dietary supplement to recommend which is jabbed into the vein daily and will cost you $400 monthly and being a 6-month program, this would sum up to $2400. 

She personally recommended to get Gastric Bypass Surgery meanwhile the nurse told me to opt for Gastric Sleeve Surgery because I am still young and it is better to not be on supplements all my life. 

Gastric Bypass Surgery

Gastric bypass procedure

Average Excess Weight Loss: 60% to 80%

Serious Complication Rate: 1.25%

Average 30 Day Mortality Rate (Death Rate): 0.14%

Procedure Type: Restrictive and Malabsorptive

Key Benefits:

  • A long history of success and clinical studies to validate its effectiveness.
  • Average of 60% to 80% excess weight loss.
  • May reduce hunger.
  • Excellent rate of diabetes cessation after surgery.
  • May relieve heartburn and acid reflux.

Key Disadvantages:

  • It is a technically challenging procedure and typically requires a bit more time under anesthesia compared to other popular bariatric surgeries.
  • Vitamins and minerals are required daily, or you’ll risk long-term nutritional deficiencies.
  • If you are prone to ulcers, discuss this with your doctor.

Gastric bypass restricts the amount you can eat and slightly reduces the amount of calorie absorption by rerouting your intestines. Some believe the re-routing of your intestines may produce a favorable change in gut hormones that increases satiety and reduces hunger.

Gastric Sleeve Surgery

Gastric sleeve diagram.

Average Excess Weight Loss: 57% to 70%

Serious Complication Rate: 0.96%

Average 30 Day Mortality Rate (Death Rate): .08%

Type of Procedure: Restrictive

Key Benefits:

  • An average hospital stay of 2 nights, but in some cases, it is an outpatient procedure.
  • Average of 60% to 70% excess weight loss.
  • May reduce hunger.
  • No foreign objects like Lap Bands.
  • No re-routing of the intestines like gastric bypass.
  • A straightforward procedure that is relatively easy to replicate.

Key Disadvantages:

  • Vitamins and minerals are required for life. However, the risk of vitamin and mineral deficiencies is lower than the duodenal switch and gastric bypass.
  • It does not improve heartburn or acid reflux and in some cases may worsen it.
  • Less long-term data compared to gastric bypass.

Rerouting your intestines is only a benefit if you prefer the least amount of anatomical change. Hunger reduction can be significant for some and not improve at all for others.

My next appointment will be on 29 April 2021 so I am gonna work on my calorie deficit diet and exercise diligently to prove my worth and my seriousness in my weight loss program.

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