Our Frequently Asked Questions section
references accepted standard of practice and guidelines
from regulatory and professional organizations including
the National Institutes of Health (NIH), American College
of Surgery (ACS), American Society for Metabolic and
Bariatric Surgery (ASMBS) As always, please check with
your healthcare provider to determine their individual
practices, guidelines and what they recommend for you.
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What
are the routine tests before surgery?
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After your
initial consultation with the bariatric team
you will be given physician orders for specific
preoperative consultations the may include the
following:
- Cardiology
- Pulmonary (to
include Pulmonary Function Studies, Arterial
blood gases and possible Sleep Study)
- GastroIntestinal (GI)
Evaluation(to include a upper endoscopy test)
- Psychiatric Evaluation
- Letter of medical
necessity from your primary care
provider (also documenting history of at
least 5 years morbid obesity)
- Laboratory Blood
Studies (To establish baseline
values for chemistries, vitamins, thyroid
function etc)
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What
is the purpose of all these tests? |
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An accurate assessment
of your health is needed before surgery. These
tests (and others) will assist us in learning more
about you and your current health conditions. As
you know weight loss surgery has known risks and
complications and by knowing all we can pre operatively
allows us the chance to decrease you risks. However
with that said remember not all risks and complications
can be avoided. |
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What
impact do my medical problems have on the decision
for surgery, and how do the medical problems
affect risk? |
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Medical problems,
such as serious heart or lung problems, can increase
the risk of any surgery. On the other hand, if
they are problems that are related to the patient's
weight, they also increase the need for surgery.
Severe medical problems may not discourage the
surgeon from recommending weight loss surgery (bypass
or banding)if it is otherwise appropriate, but
these conditions will make a patient's risk for
complications higher. |
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Why
do I have to have a Gastroenterology (GI) Evaluation? |
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Many patients who
are morbidly obese have gastrointestinal symptoms
and or conditions which they may or may not be
receiving appropriate treatment. These symptoms
may include heartburn, increased belching or passing
gas, or pain. Sometimes the pain may be caused
by a hernia in your esophagus or irritation of
the lining of your stomach known as an ulcer. An
upper endoscopy will allow the physician to see,
diagnose and treat any of the above. The treatment
plan and monitoring of these conditions allows
you to preparing the inner lining of your stomach
and intestines for the weight loss procedure you
are seeking. |
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Why
do I have to have a Pulmonary Evaluation? |
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This type of evaluation
gives you a better understanding of the status
of your respiratory system which is important with
respect to general anesthesia and your pain management.
The pulmonary function study and arterial blood
gases allow the anesthesiologist to plan for your
anesthesia care the day of your surgery. The sleep
study also allows for this but provides you with
the opportunity to better care your respiratory
disease (if detected). Conditions such as sleep
apnea are very common in the morbidly obese and
if undetected is associated with a high mortality
rate for anesthesia and weight loss surgery. Your
pulmonary doctor will explain in detail the disease
of sleep apnea and discuss with you the options
for treatment. |
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Why
do I have to have a Psychiatric Evaluation? |
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A psychiatric evaluation
is ordered most commonly because your insurance
company may require it and our team would like
confirmation that if there is a pre existing condition
such as depression or bipolar; that you are currently
being treated appropriately. Most psychiatrists
will evaluate your understanding and knowledge
of the risks and complications associated with
weight loss surgery and your ability to follow
the the required lifestyle changes after surgery. |
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If
I want to undergo a weight loss procedure (gastric
bypass or gastric banding), how long do I have
to wait? |
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After attending
the mandatory informational
session, your first
consultation with the bariatric team can be scheduled
within 3-4 weeks. The amount of time between the
first consultation and the date of surgery depends
on several factors which include appointments for
necessary pre operative
medical consultations and
meeting the required
insurance criteria for surgical
authorization. |
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What
can I do before my initial appointment with the
bariatric team to speed up the process of getting
ready for surgery? |
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Select a primary care physician
if you don't already have one, and establish
a relationship with him or her. Remember most
insurance companies are asking primary care
providers to document in their letter of medical
necessity that you have been under their care
for at least 5 years for morbid obesity. Work
with your primary care provider to ensure that
your routine health maintenance testing is
current. For example, women may have a pap
smear, and if over 40 years of age, a breast
exam. And for men, this may include a prostate
specific antigen test (PSA).
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Verify with your current
insurance plan that weight loss surgery is a
covered benefit and if possible obtain any of
the required criteria for surgical authorization.
You are not authorizing the surgery (the surgeon
must do this) you are simply making sure it is
a covered benefit with your plan. You will also
be given information related to your responsibilities
for co insurance and co pay amounts. The following
are procedure codes sometimes asked when you
are verifying benefits:
- Laparoscopic
Roux en Y Gastric Bypass
(43644)
- Laparoscopic
Adjustable Gastric Banding
( 43659 )
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Call the office (if you have
not already) for an initial patient screening
and directions on how to register your personal
health information on line and upcoming dates
for the required informational session attendance.
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Make a list of all the diets
you have tried (a diet history), giving dates
of when started, How long you stayed on a diet
and how much you lost or gained. (Honest approximation
is acceptable)
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Stop Smoking if you smoke.
You must be at least 3 months smoke free prior
to scheduling surgery.
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Gather any pertinent medical
data such as reports of special tests (echocardiogram,
sleep study, etc.) or surgical reports for past
surgeries you may have received..
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Gather list of your current
medications with dose and schedule. Also include
any over the counter medications you take routinely
such as vitamins, pain relievers.
- Insurance
Issues
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