Baby tiger dies at Calgary Zoo Gillespie won’t let the pain bowl him over

At five-feet, seven-inches and more than 500 pounds — he doesn’t know how much more — Jake Carte has plenty of health problems. The 26-year-old Saanich man has spent the past 20 days in Royal Jubilee Hospital, nearly half of them drifting in and out of consciousness in the intensive care unit. Now recovering, Carte says the crisis began when a skin infection called cellulitis on his left leg turned septic, then spread to his bowel and respiratory system, threatening his life.

“I ended up in hospital because I was having lots of trouble breathing,” he says from his hospital bed, where he is still receiving oxygen and is hooked up to several IV lines, including one designed to detect blood clots.

Carte was admitted the day before he was due to see Victoria surgeon Dr. Brad Amson, a specialist in weight-loss surgery. He was desperately hoping to be assigned a date for weight-loss surgery by the end of 2011.

Now Carte doesn’t know when his next consultation will be. In any event, he has been told the hospital will be home for the next several weeks.

“It’s going to be a while before I walk,” he says. Heavy all his life, Carte at one point got his weight down to 300 but is now in “the super morbid obesity class” that makes activity difficult.

Along with hundreds of other morbidly obese British Columbians, Carte is demoralized, frustrated and facing longer waits and potential health deterioration due to a major reduction in bariatric surgeries in B.C.’s public health system. Meanwhile, weight-loss procedures are being ramped up in Ontario and Alberta.

Bariatric surgeons in B.C. manage their own waiting lists independently, with waits that vary from 18 months to two years, according to the B.C. Ministry of Health — an estimate dismissed by Ron Merk, Victoria spokesman for WLS (Weight Loss and Surgery) Support. He asserts the wait now approaches six years.

Amson, who performs most of the B.C. surgeries, did not respond to interview requests but said in 2009, at the time of the cuts, that there were 800 people waiting in B.C. The Vancouver Island Health Authority will accommodate only 52 surgeries this year.

The Health Ministry website lists 473 people waiting for bariatric surgery; 456 of them in Victoria, where most of the surgeries are performed.

The situation suggests “there’s virtually nothing left for people,” in B.C., says Dr. Daniel Birch, founding member of the Canadian Association of Bariatric Physicians and Surgeons.

“It’s absolutely devastating and I’d really like to hear an explanation from the people that made those decisions,” says the Edmonton expert. “I think they should answer to the physicians and surgeons in B.C. who have asked for help, and to the patients who have asked to manage this issue and disease.”

The problem in B.C. is not a shortage of general surgeons willing to manage obesity, Birch contends. “The problem is at a higher level — administrations, surgical leadership and politics — that’s where we’re hitting the roadblocks.”

Meanwhile, Carte receives a monthly B.C. disability benefit of $906 — which in a year approaches the $13,000 cost of bariatric surgery at the same hospital where he’s now staying.

Until now, Carte didn’t know about cellulitis, although it’s one of many conditions from arthritis to high blood pressure and diabetes that are more common in obese people.

“If I weighed less, it probably wouldn’t have been as big a deal.

“If I can hear a date for surgery, I think that would give me motivation. My life feels like it’s in the balance until I have the surgery.”

Under pressure to cut a $45-million overrun on its $1.7-billion budget in 2009, the Vancouver Island Health Authority reduced the annual number of bariatric surgeries from 124 in 2008 to 52 for 2010-11.

VIHA’s entire surgical program was over budget by more than $2 million and it had to be reduced, says VIHA spokeswoman Shannon Marshall. Bariatric surgery must be balanced against operating-room time, medical and nursing staffing, financial resources and all other important surgical procedures.

Given that many bariatric surgeries are performed on patients from the mainland, “we need to work with other health care jurisdictions to ensure O.R. access is not compromised for patients requiring other procedures,” Marshall says.

Carte knows surgery itself isn’t the only answer, “but I think it’s going to be a huge key factor in me getting healthy.” He gets support from his family — he’s one of seven children — the support group and his church, Colwood Pentecostal.

While surgeons are often stymied by the politics of obesity, the associated conditions — unchecked diabetes and respiratory problems — continue to mount, Birch says. Ironically, the health system will treat everything from diminished blood flow to the legs to cardiac conditions or knee replacement for morbidly obese patients without treating the body weight that causes it all.

“It makes no sense — it’s all backwards,” Birch says. A waiting list approaching 500 is “ridiculous — it essentially says you’re not managing the disease.”

Last May, the Provincial Health Services Authority was asked by the ministry to look at whether a provincial program rather than so much dependence on a single Victoria surgeon would be a better way of dealing with bariatric surgery.

There were no official terms of reference, but the report is expected early this year. Options under review include an increase in the number of procedures funded, a centre for surgery in the Lower Mainland and MSP coverage for reversible banding surgeries, ministry spokesman Ryan Jabs confirms.

“We acknowledge the challenge of VIHA continuing to perform the majority of bariatric surgeries in the province and B.C.’s current capacity to deliver this type of surgery,” Jabs says. “This, along with emerging research on the health care costs of obesity and the potential benefits of bariatric surgery is why we are conducting our review.”

Kris Greene, Victoria-based president of the B.C. Association of Bariatric Advocates, questions the timing. “They definitely should have had the discussion and done their research before doing any cutbacks,” she says. “Because by doing the cutbacks, instead of saving lives, they’ve reduced people’s lifespan.”

Greene, 40, finds it encouraging that the issue is being discussed, but “it would be more encouraging if they actually added some more O.R. time — or more funding.”

Amson, one of three surgeons performing bariatric procedures in Victoria, told the Times Colonist at the time of the cuts that the resulting improvements in the health of patients more than covers the costs.

Severe obesity is reaching epidemic proportions in Canada as it is in the rest of the western world and “the only permanent treatment for severe or morbid obesity is bariatric surgery,” says a study published in the Canadian Journal of Surgery in 2009.

Unlike other health problems with a lifestyle component, obesity hasn’t reached acceptance as a chronic disease in Canada, even among doctors, Birch says. “It’s a great challenge. . . . We’ve gained comfort with disease related to smoking, alcoholism and even traumas related to violence. We’re just not there yet with obesity.”

Weight-loss surgery is necessary, says Greene. “It should not be considered elective.” Greene weighed 308 pounds when she had gastric bypass surgery nearly seven years ago, after a 29-month wait. She weighs 138 today, and walks a lot and does yoga to maintain her weight.

Weight-loss surgery has transformed her life, enabling her, along with a healthy diet and daily exercise “to be the person I always was, but never was. The cycle of obesity in my family line has been broken; I can now teach my children by example.”

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