Getting Sleeved in Japan (Pre-Op)

[ebert 10]

Hi Everyone,

I just got my stomach sleeved a week ago. I'm in phase one of my post-op diet, having crazy "head hunger" issues, and I thought I should do something productive instead of thinking about food I can't eat. So I'm going to explain how I got the sleeve in Osaka, Japan. This might be of interest in case you are (like me) a foreigner living in Japan, or if you are interested in how the Japanese pre-op procedures differ from those in other countries.

Finding a Bariatric Surgeon (Nov, 2013)

This was a hard part. If you've ever been to Japan, you've probably noticed that most Japanese people don't have significant weight issues. Obese Japanese people are very rare, as are foreigners in general. Because of this, I always assumed that if I were to get the sleeve surgery, I'd have to go to another country to get it done, which seemed really cost-prohibitive. Although I've wanted the sleeve for years, I labored under this impression (been in Japan almost a decade), but it turns out that's not the case. There are surgeons here who do the sleeve procedure.

My employer mandates an annual physical, and every year the doctor told me useless things like, "did you know you are overweight?" and "have you tried taking 20-30 minute walks each night?" I don't blame the doctor--average checkup doctors simply don't encounter fat people very often, and they probably haven't studied up on options to help obese people. But because I knew that I'd be told these things again at the annual checkup, I googled "gastric sleeve Japan" and found an obscure article about a team of bariatric surgeons doing the procedure in Kyushu. I printed out the article, and before the doctor told me to try exercise, I gave him the printout. "I want this," I said. He looked at the article, told me he'd research it and get back to me. Less than a week later, he told me that, right here in Osaka, there is a bariatric team that does the sleeve. He gave me a referral, and a week later I had my first appointment.

If you live in Japan and would like to find a surgeon, that's the way to do it. It would seem that living in Tokyo, Osaka, or Kyushu would be easiest, but if you live elsewhere you might still find a bariatric surgeon near you.

Meeting the Bariatric Team (Dec, 2013)
I went to Osaka University Hospital in December to meet the doctors. I had no idea what to expect, and I tried to lower my expectations by expecting disappointment. The surgery will be too cost-prohibitive because everything in Japan is expensive, or, They won't be willing to work with me because my Japanese ability will interfere with vital communication. Turns out I was wrong about both of those things. The head of the bariatric team told me it'd be possible, but only after a long wait--Osaka University Hospital mostly uses its Operating Rooms for severe cancer patients, and would-be sleevers often get their surgery dates abruptly postponed.

As for the costs, I was told that my insurance would cover the medicine and hospital stay, but wouldn't cover the surgery. This was disappointing to hear, but when I asked him what the surgery would cost, he told me they generally charge about 500,000¥ (~$5000). That's not too bad, I thought. I also learned that the surgery cost could be split up into monthly payments, making it even more manageable. This was really encouraging news.

Next I had to do an exercise test (to see how quickly my breathing rate would rise), a spirograph lung capacity test, a pee test, a CT scan, and countless blood tests and x-rays. They also weighed me at 168 kg (370 pounds). This was an issue--their medical machines are only safe for people weighing a maximum of 150 kg (330 pounds). This was a depressing irony--I was too fat to qualify for a surgery for people who are too fat. Instead of giving up on me, they gave me an appointment with a local nutritionist and told me to get my weight down.

Working with the Nutrition Doctor (Dec 2013-March 2014)
The NUT did an ultrasound on my heart, revealing that the veins and arteries of my heart were more swollen and large because of my size. He gave me a dieting book (to add to my collection of diet books) that he did primary research for when he studied nutrition in America. Although I was happy the book was in English, I wasn't terribly impressed by its insights--nothing revelatory.

But the NUT also prescribed me Sanorex, an amphetamine designed to suppress my appetite and stimulate my metabolism. This pill was very effective--instead of getting hungry, I'd just get agitated and jumpy, but small salads left me full and my carb-cravings went way down. Unfortunately, the laws in Japan prohibit doctors from prescribing Sanorex for a period longer than three months in order to prevent people from getting addicted (three months on, three months off, three months on = OK).

I didn't want my weight yo-yoing with some diet pill while I danced my way closer to 150 kg, so I worked hard and, by the beginning of March, got my weight down to 154 kg. The bariatric surgeon thought this was close enough, and on March 19, phoned me and told me my surgery had been scheduled for March 26.

Surgery Preparation (March 24-26)

My brother who lives in America also got the sleeve two years prior, with very good results. But from conversations with him, I knew that the typical procedure in America is to fast for two weeks prior to surgery. I thought this two week fast would be used in Japan, but nope. Perhaps this is the way all over Japan, or perhaps it's a policy of Osaka University Hospital due to their occasional postponement of sleeve surgeries in favor of more serious cancer surgeries other patients have.

What I did have to do was admit myself to the hospital two days prior to the surgery. The American way of doing this procedure with just a night or two in the hospital is something that Japanese hospitals don't. They prefer much longer hospital stays--this could be an effort to get more money, or it could be due to extreme risk-aversion that is a characteristic of Japanese culture. They wanted me there two days before the surgery, and seven days after. I was willing to do two days before (especially in lieu of a two-week fast), but seven days after seemed a bit excessive to me. They agreed to shorten the post-op time to four days.

I checked in Monday morning on March 24, and they hooked me up to an IV which "fed" me for the next two days. During that time, I did more X-rays, more blood tests, and an attempted gastroscopy which the doctor aborted because I couldn't stop gagging on the camera, even with heavy anesthetic. (I asked if they were going to try the gastroscopy again with heavier anesthesia or possibly even sedation, and the doctor said "nah," leading me to wonder why they even tried in the first place.)

They also took me to the OR, where they tested me on the table. Turns out they weren't kidding about a 150 kg weight-limit. The table was designed for smaller Japanese bodies, and they had to do lots of adjustments so that it would accommodate my frame.

Finally, the night before the surgery, there was a big "informed consent" meeting, with the head surgeon, anesthesiologist, head nurse, several other doctors, and a NUT. They even brought in a translator who worked in a different hospital two hours south. During the meeting, the surgeon explained the risks of the surgery and the NUT went over my post-op diet instructions. He also gave me a choice of bougie--36 or 40. I picked 36, asked a lot of questions, signed a bunch of forms, and that concluded the meeting.

Afterward, back in my bed, the nurse shaved my stomach, gave me a potent laxative and, after my eventful bowel movement, a sleeping pill. I woke up the next morning around six. The nurse gave me an enema (first time for that--hopefully the last time). After that, I was escorted to the OR, where they strapped me onto their modified table and sedated me.

The End (of the beginning…)
And that concludes my epic account of the events leading up to my gastric sleeve surgery in Japan. Tomorrow, when I feel similar "head hunger issues," I'll probably write a similar recap of the week following the surgery, only I'll put it in the "post-op" section. I realize this post was likely too long and too detailed for most people, but hopefully some people found it interesting and informative. Perhaps others were able to use it to help fall asleep. I confess to being self-indulgent: writing all this down helped me stop obsessing about the food I won't be able to eat for a long time.

[woo woo 872]

Thank you for sharing, this is very interesting! Enjoyed it very much Please post again!

[Ladybug123 33]

Hi Everyone,

I just got my stomach sleeved a week ago. I'm in phase one of my post-op diet, having crazy "head hunger" issues, and I thought I should do something productive instead of thinking about food I can't eat. So I'm going to explain how I got the sleeve in Osaka, Japan. This might be of interest in case you are (like me) a foreigner living in Japan, or if you are interested in how the Japanese pre-op procedures differ from those in other countries.

Finding a Bariatric Surgeon (Nov, 2013)

This was a hard part. If you've ever been to Japan, you've probably noticed that most Japanese people don't have significant weight issues. Obese Japanese people are very rare, as are foreigners in general. Because of this, I always assumed that if I were to get the sleeve surgery, I'd have to go to another country to get it done, which seemed really cost-prohibitive. Although I've wanted the sleeve for years, I labored under this impression (been in Japan almost a decade), but it turns out that's not the case. There are surgeons here who do the sleeve procedure.

My employer mandates an annual physical, and every year the doctor told me useless things like, "did you know you are overweight?" and "have you tried taking 20-30 minute walks each night?" I don't blame the doctor--average checkup doctors simply don't encounter fat people very often, and they probably haven't studied up on options to help obese people. But because I knew that I'd be told these things again at the annual checkup, I googled "gastric sleeve Japan" and found an obscure article about a team of bariatric surgeons doing the procedure in Kyushu. I printed out the article, and before the doctor told me to try exercise, I gave him the printout. "I want this," I said. He looked at the article, told me he'd research it and get back to me. Less than a week later, he told me that, right here in Osaka, there is a bariatric team that does the sleeve. He gave me a referral, and a week later I had my first appointment.

If you live in Japan and would like to find a surgeon, that's the way to do it. It would seem that living in Tokyo, Osaka, or Kyushu would be easiest, but if you live elsewhere you might still find a bariatric surgeon near you.

Meeting the Bariatric Team (Dec, 2013)

I went to Osaka University Hospital in December to meet the doctors. I had no idea what to expect, and I tried to lower my expectations by expecting disappointment. The surgery will be too cost-prohibitive because everything in Japan is expensive, or, They won't be willing to work with me because my Japanese ability will interfere with vital communication. Turns out I was wrong about both of those things. The head of the bariatric team told me it'd be possible, but only after a long wait--Osaka University Hospital mostly uses its Operating Rooms for severe cancer patients, and would-be sleevers often get their surgery dates abruptly postponed.

As for the costs, I was told that my insurance would cover the medicine and hospital stay, but wouldn't cover the surgery. This was disappointing to hear, but when I asked him what the surgery would cost, he told me they generally charge about 500,000¥ (~$5000). That's not too bad, I thought. I also learned that the surgery cost could be split up into monthly payments, making it even more manageable. This was really encouraging news.

Next I had to do an exercise test (to see how quickly my breathing rate would rise), a spirograph lung capacity test, a pee test, a CT scan, and countless blood tests and x-rays. They also weighed me at 168 kg (370 pounds). This was an issue--their medical machines are only safe for people weighing a maximum of 150 kg (330 pounds). This was a depressing irony--I was too fat to qualify for a surgery for people who are too fat. Instead of giving up on me, they gave me an appointment with a local nutritionist and told me to get my weight down.

Working with the Nutrition Doctor (Dec 2013-March 2014)

The NUT did an ultrasound on my heart, revealing that the veins and arteries of my heart were more swollen and large because of my size. He gave me a dieting book (to add to my collection of diet books) that he did primary research for when he studied nutrition in America. Although I was happy the book was in English, I wasn't terribly impressed by its insights--nothing revelatory.

But the NUT also prescribed me Sanorex, an amphetamine designed to suppress my appetite and stimulate my metabolism. This pill was very effective--instead of getting hungry, I'd just get agitated and jumpy, but small salads left me full and my carb-cravings went way down. Unfortunately, the laws in Japan prohibit doctors from prescribing Sanorex for a period longer than three months in order to prevent people from getting addicted (three months on, three months off, three months on = OK).

I didn't want my weight yo-yoing with some diet pill while I danced my way closer to 150 kg, so I worked hard and, by the beginning of March, got my weight down to 154 kg. The bariatric surgeon thought this was close enough, and on March 19, phoned me and told me my surgery had been scheduled for March 26.

Surgery Preparation (March 24-26)

My brother who lives in America also got the sleeve two years prior, with very good results. But from conversations with him, I knew that the typical procedure in America is to fast for two weeks prior to surgery. I thought this two week fast would be used in Japan, but nope. Perhaps this is the way all over Japan, or perhaps it's a policy of Osaka University Hospital due to their occasional postponement of sleeve surgeries in favor of more serious cancer surgeries other patients have.

What I did have to do was admit myself to the hospital two days prior to the surgery. The American way of doing this procedure with just a night or two in the hospital is something that Japanese hospitals don't. They prefer much longer hospital stays--this could be an effort to get more money, or it could be due to extreme risk-aversion that is a characteristic of Japanese culture. They wanted me there two days before the surgery, and seven days after. I was willing to do two days before (especially in lieu of a two-week fast), but seven days after seemed a bit excessive to me. They agreed to shorten the post-op time to four days.

I checked in Monday morning on March 24, and they hooked me up to an IV which "fed" me for the next two days. During that time, I did more X-rays, more blood tests, and an attempted gastroscopy which the doctor aborted because I couldn't stop gagging on the camera, even with heavy anesthetic. (I asked if they were going to try the gastroscopy again with heavier anesthesia or possibly even sedation, and the doctor said "nah," leading me to wonder why they even tried in the first place.)

They also took me to the OR, where they tested me on the table. Turns out they weren't kidding about a 150 kg weight-limit. The table was designed for smaller Japanese bodies, and they had to do lots of adjustments so that it would accommodate my frame.

Finally, the night before the surgery, there was a big "informed consent" meeting, with the head surgeon, anesthesiologist, head nurse, several other doctors, and a NUT. They even brought in a translator who worked in a different hospital two hours south. During the meeting, the surgeon explained the risks of the surgery and the NUT went over my post-op diet instructions. He also gave me a choice of bougie--36 or 40. I picked 36, asked a lot of questions, signed a bunch of forms, and that concluded the meeting.

Afterward, back in my bed, the nurse shaved my stomach, gave me a potent laxative and, after my eventful bowel movement, a sleeping pill. I woke up the next morning around six. The nurse gave me an enema (first time for that--hopefully the last time). After that, I was escorted to the OR, where they strapped me onto their modified table and sedated me.

The End (of the beginning…)

And that concludes my epic account of the events leading up to my gastric sleeve surgery in Japan. Tomorrow, when I feel similar "head hunger issues," I'll probably write a similar recap of the week following the surgery, only I'll put it in the "post-op" section. I realize this post was likely too long and too detailed for most people, but hopefully some people found it interesting and informative. Perhaps others were able to use it to help fall asleep. I confess to being self-indulgent: writing all this down helped me stop obsessing about the food I won't be able to eat for a long time.

I really enjoyed reading about your journey. Thanks for sharing.

[honeybunz 139]

Me too! Thanks!

Edited April 1, 2014 by honeybunz

[MichyDown 0]

Hi,

I was wondering how you are doing so far? I am trying to get the sleeve in Osaka but I cannot seem to find anyone that will do it. Would you happen to still have your doctor's information?

[kfoster67 0]

MOVING TO IWAKUNI 8 MONTHS AFTER SLEEVE

My surgeon said I really need to find a bariatric team in Japan since I am moving there august 2017.

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