Saturday, May 10, 2008

Estonian Healthcare - Redux & Personal

I've written before about Estonian healthcare - how it's considered crap, though probably undeservedly. Of course, it is difficult to pass judgement on a system that you've only ever used for trivial matters. I've had major surgery when I was very young, but that was still in the Soviet times and I remember nothing of it. Otherwise I never had cause to avail myself of Estonia's hospitals for anything more serious than an adenoid removal, which took half a day and resulted in as much ice cream as I could eat; not a complete waste, then. A couple of years ago I got into a fairly impressive car accident, was ambulanced to Tallinn and checked over at the ER; I was sent home the same evening with some stitches and a concussion. That was luck. But in 2008, I've been deliberate.

I'm a big guy. Always have been. I'd resigned myself to being fat for the rest of my life; and then I decided I was going to do something about it. The key factor was the appearance of bariatric surgeons in Estonia; but the turning point was late last fall, after I'd been swimming regularly, three times a week, for about half a year. I was feeling a lot better and gaining muscle mass, but not really losing much weight. My last bit of self-deception - that I could get into shape through diet and exercise - fell away: there is no way I will ever have the sort of self-discipline for the sort of massive weight loss I need. There are people in the world who've done it, and I have the greatest respect for them, but that's not me. Growing up fat meant a lot of confidence issues; Antyx readers will recognize that confidence is not something I have a problem with. The way I did was to stop hating myself. Self-discipline on the order required to go from the clinical definition of morbidly obese to more or less normal would have to stem from a burning hate for my own body; and that is not a choice I am prepared to make. Even if it kills me.

Fortunately, I now have the opportunity to cheat; to achieve the result while bypassing the part that makes it so difficult for me. Not that the cheat itself is particularly simple, but it's something I can do. There are surgeons in Estonia who do the operations that result - reliably - in radical weight loss; I am still young and have most of my health; and I can afford the surgery. I'm paying a little over two thousand Euro for it, which isn't a lot. Thanks to the Estonian healthcare system.

My first move was at the end of 2007, when I saw my GP (or rather one of the GPs sharing a pool of patients) for a severe sore throat. I got a week's bedrest and a referral to an endocrynologist - a specialist on metabolism. Since this was not an urgent matter, I got put in the back of the queue; a little over a month till my visit.

When the time came, it was all remarkably efficient. I paid 50 EEK (3 Euro and change) for the initial visit. The doctor ran a bunch of tests, some that afternoon, the rest on the next morning. A week later I got the results, with commentary, and some research on the state of bariatric surgery in Estonia. The doc confirmed the diagnosis I'd known already: hyperinsulinemia, the most remarkable thing about which is that it is not diabetes. What it does do is cause an appetite disproportional to consumption. By this time I'd recognized that I eat more than most people; but I do it without really thinking about it. It's the difference between hunger and appetite, and it's something that ought to be fixed well by an operation that constricts the volume of the stomach. The endocrynologist gave the go-ahead.

I then contacted the surgeon, from a Tallinn private practice. It took a while to set up a visit, and when I did travel to the capital, it turned out that he was in surgery; apparently he actually works as a gastric surgeon on the staff of Tallinn's regional hospital as well. Fair enough, really; but what I did find out was that the metabolism workup was not sufficient. I'd also need to be cleared by a gastroenterologist. Fortunately, I could do that in Tartu.

This time I didn't feel like waiting a month, so I cheated. I paid the university hospital for an unreferred visit to a specialist doc. My 300 EEK (20 Euro) got me a time within two business days of putting in the request on the hospital's website. Since I did actually have national health insurance, that was all I paid; the ultrasound, gastroscopy and doctor's consult were all free. The GE was one of those old doctors that somehow instill tremendous trust. (I've never been afraid of docs, not even of needles when I was very little; an old relative that died before my birth had been something important in Estonian medicine, so all through my childhood various doctors had been very pleased to meet an heir to that family. Comes with having an uncommon last name.) She gave me the OK, and mentioned what she knew about the bariatrics in Tallinn; some 70 surgeries had been performed successfully there.

Most of those were of the really hardcore kind. There are three types of surgery available, and the most radical one is an actual bypass, where the patient's guts are rerouted. (Curiously enough, since it's purely surgical and does not involve any medical gadgets, it gets paid for in full by the national health insurance.) The least invasive type is the gastric balloon, which they insert through a tube down your throat - but it stays there for no more than 6 months, and I needed a longer-lasting effect than that. So I'm getting a lap band - a sort of belt that gets tied around the top part of the stomach. The upshot is that very little food can actually fit in there, so I can't overeat - and apparently most of the nerve endings are at the top of the stomach, so I constantly feel really full. It's not a magic pill, but it's been around for decades, and it seems to really work.

The great thing about the lap band surgery is that they're not cutting any internal organs - just adding a new bit. Sounds safer than removing an appendix.

Today, after my extended three-day birthday celebrations involving cake and a last Chateubriand stake from the Crepp meatery, I weigh 149.8kg. My surgery is on Wednesday. I'm about to put my gut where my blogging finger is.


klx said...

health and luck to you :)

Jens-Olaf said...

Yep, good luck.
And a tip for you exercises. What you are doing is good for your health and strenght but loosing weight it needs maybe more duration or change of intensity. In German it is easier to find some reliable sources about fatburning and training on the internet. In English there is a lot of commercial crap. But good articles to be found.

Kristopher said...

I'm a little concerned about the medical indication. I understand that you are on a mission and I salute you. I just wouldn't have even laparoscopy on a placebo theory, or that "it should seem to work". So I don't feel guilty about asking some questions.

You didn't say what is the cause of your hyperinsulinemia. A lot of times "hyperinsulinemia" is essentially another name for pre-diabetes. The body is conditioned to produce too much insulin to deal with excess sugar.
It can be caused by diet and can be reversed by diet. Check out Sugar Blues (1975) -- somewhat dated but no reason to doubt the case studies. People did not have to undergo months of hell before their chemistry changed.

If your hyperinsulinemia is underlying (pancreatic etc), I still don't understand the logic. If a person's stomach is physically smaller, couldn't that potentially be dangerous? What if they have just eaten a high-protein meal and there is no more room for food...but their blood sugar is still dangerously low?

In fact, isn't this a contraindication in the wiki article on the lap belt surgery -- "untreated endocrinal condition"?

antyx said...

I just wouldn't have even laparoscopy on a placebo theory, or that "it should seem to work".

Well no, it does work - I've had two Tartu docs with no vested interest at all tell me that yes, I should do it, and it's a known, popular procedure. My point was, unlike magic pill stuff, I actually understand how it would indeed be effective.

You didn't say what is the cause of your hyperinsulinemia.

Born with it. It got diagnosed first when I was very little, maybe 7-8 years old. It's been 24 years and still hasn't developed into diabetes, fortunately (and from what the doc told me, even if it does, it definitely won't be the fuck-me sort of diabetes where you carry insulin syringes with you all the time).

If a person's stomach is physically smaller, couldn't that potentially be dangerous?

Yes, but less so with this version. Proper gastric bypasses result in malabsorption, people have to take supplements. Here, the working surface of the stomach remains the same, etc. - I just can't have much food at any one time.

In fact, isn't this a contraindication in the wiki article on the lap belt surgery -- "untreated endocrinal condition"?

Which is why I have a piece of paper from an endocrynologist saying "patient has no contraindications for this surgery". ;)

Chikiness said...

All the best with the surgery and 'new body part'...and with your health.

Doris said...

If you feel like it, you can read my entry on Dutch health (isurance) system. Now THAT's a nightmare :)

Good luck with the surgery!

Doris said...

iNsurance, i meant


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