FREQUENTLY ASKED
QUESTIONS
GENERAL
What is the youngest patient you can operate
on?
What is the oldest patient you can operate on?
What are the routine tests before surgery?
What is the purpose of all these tests?
Why do I have to have a GI evaluation?
Why do I have to have a Psychiatric Evaluation?
INSURANCE
ISSUES
How long does it take to schedule surgery?
Why does it take so long to get insurance
approval?
How can they deny insurance coverage
for a life-threatening disease?
What can I do to help the process?
SURGERY
Does laparoscopic surgery decrease the
risk?
How long does surgery last?
Will I have a lot of pain?
How long do I have to stay in the hospital?
Do you use a drain?
How soon will I be able to walk?
How soon can I drive?
When can I leave the area?
LIFE
AFTER SURGERY
Why can't I eat red meat after surgery?
What is Dumping Syndrome?
What is the problem with milk products?
What do I do to use the Gastric Bypass "tool"
successfully?
Why can't I snack between meals?
Why drink so much water?
What's so important about exercise?
GENERAL
What
is the youngest patient you can operate on?
We have performed surgery on patients as young as 16 years of
age. In this age group, we are concerned that the patient make
the decision for surgery him/herself and that there be a full
understanding and commitment to the altered eating pattern which
will be necessary for success.
What
is the oldest patient you can operate on?
Patients over 65 require very strong indication for surgery and
must also meet Medicare criteria. The risk of surgery in this
age group is increased and the benefit, in terms of reduced risk
of mortality, is reduced. In many instances, this argues against
surgery.
What
are the routine tests before surgery?
We always do certain tests: a complete blood count (CBC), urinalysis,
and a chemistry panel, which gives us a readout of about 20 blood
chemistry values. We do a glucose tolerance test to evaluate for
diabetes. Most persons, except for the very young, get a chest
x-ray and an electrocardiogram (EKG). We do an abdominal ultrasound
to look for abnormalities of the ovaries or uterus (female) and/or
gallbladder (to check for gall stones). Other tests which we frequently
order when indicated include pulmonary function testing, echocardiogram,
sleep studies, GI evaluation or cardiology evaluation.
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What
is the purpose of all these tests?
Primarily, we need an accurate assessment of your health before
undertaking a big operation. The best way to treat a complication
is never to have it in the first place, due to advance knowledge.
We
want to know if your thyroid function is adequate (hypothyroidism
can lead to sudden death post-operatively), if you are diabetic
(we will have to take special steps to control your blood sugar),
if your heart is sound (surgery increases cardiac stress). We
look for signs of liver malfunction, breathing difficulties, excess
fluid in tissue, abnormalities of the glands and mineral in body
fluids and abnormal blood fat levels.
Why
do I have to have a GI evaluation?
Patients who have significant gastrointestinal (GI) symptoms such
as upper abdominal pain, heartburn, belching sour fluid may have
serious underlying problems such as hiatal hernia, gastraesophagael
reflux or a peptic ulcer. For example, many patients have symptoms
of reflux and we know that up to 15% of such persons may have
changes in the lining of their esophagus, which could predispose
to cancer.
When
our physicians detect GI symptoms on your preliminary evaluation,
we ask that you have an evaluation prior to surgery, so that we
can take care of them at the same time to avoid complications
at surgery.
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Why
do I have to have a Psychiatric Evaluation?
We do not believe that people with weight problems are crazy!
When our office asks for a psychiatric evaluation, by far the
most common reason is that your insurance company requires it.
Normally we ask a psychiatrist to evaluate your understanding
and knowledge and the ability to follow the basic recovery plan.
Few people are disqualified by the psych evaluation.
INSURANCE
ISSUES
How
long does it take to schedule surgery?
We can ordinarily schedule surgery within 2-3 weeks once financial
arrangements are made. Insurance approval is a prerequisite for
many reasons. When we obtain approval, we contact you to determine
if and when you are ready to schedule surgery. From that time,
surgery can be done in 2-3 weeks or at your convenience.
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Why
does it take so long to get insurance approval?
From the time when your consultation is completed, it usually
takes us 1-2 days to send a letter to your insurance carrier to
start the approval process. The time that it takes to get an answer
can vary from about 3-4 weeks to as long as they can dawdle without
being asked. Our staff members try to follow up regularly on the
approval request.
We
are trying to speed up our process but it really does help when
you as the patient, get behind the process and call your insurance
company regularly to inquire on the status of the request.
How
can they deny insurance coverage for a life-threatening disease?
Coverage may be denied because there is a specific exclusion in
your policy for obesity surgery or "treatment of obesity",
which is manifestation of the attitude of our society toward obesity
and the discrimination which obese persons suffer. Such exclusions
can often be attacked, by the reasoning that the surgical treatment
is recommended as the best therapy for co-morbidities, which are
usually covered.
Coverage
may also be denied for "lack of medical necessity".
A therapy deemed to be medically necessary when it is needed to
treat a serious or life-threatening condition. In the case of
Morbid Obesity, alternative
treatments are considered to exist - according to conventional
wisdom - such as dieting, exercise, behavior modification and
some medications. Usually medical necessity denials hinge on the
insurance companies demand for some form of documentation such
as 1-5 years of physician-supervised dieting or a psychiatric
evaluation. The best approach to these demands is to try to produce
reasonable documentation and information. Once you have successfully
jumped over all the obstacles, it is more difficult for you to
be denied.
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What
can I do to help the process?
First, help us to get all the information (diet records, medical
records, medical tests) together, so the carrier cannot deny for
failure to provide "necessary" information. Letters
from your personal physician and consultants, attesting to the
"medical necessity" of treatment, are particularly valuable.
When one or several physicians corroborate the necessity of treatment,
it will be hard for the carrier to contradict them.
When
the letter is submitted, call your carrier regularly (once per
week), to ask about your status. You may also be able to protest
unreasonable delays through your employers or human relations/personnel
office.
SURGERY
Does
laproscopic surgery decrease the risk?
No. Laproscopic operations carry the same risk as the similar
procedure performed as an open operation. The benefits of
laproscopy
are typically less discomfort, shorter hospital stay, earlier
return to work and much reduced scarring.
How
long does surgery last?
Typically, the gastric bypass surgery will require 2-3 hours of
total time in the operating room.
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Will
I have a lot of pain?
We try very hard to control pain after surgery, to make it possible
for you to move around quickly and become more active. Most of
our patients are pleasantly surprised how little discomfort they
experience.
How
long do I have to stay in the hospital?
As long as it takes to become self-sufficient. Typically, the
hospital stay (including the say of the surgery) is two days for
laproscopic gastric band and three days for open gastric bypass.
Do
you use a drain?
Most patients will have a small tube to allow drainage of accumulated
fluid from the abdomen. The is a safety measure and can be removed
a few days after the surgery. It produces no more than minor discomfort.
How
soon will I be able to walk?
Almost immediately after surgery. Patients walk or stand at their
bedside on the night of the surgery and take several walks the
next day and thereafter. On leaving the hospital, you will be
able to care for all your personal needs, but will need help with
shopping and with transportation.
How
soon can I drive?
We recommend that you do not drive until you have stopped taking
narcotic medications and can move quickly and alertly to stop
your car, especially in an emergency.
When
can I leave the area?
Patients who come from outside the Seattle/Tacoma area are required
to remain in the vicinity for at least one week after the day
of surgery. There are important educational sessions, as well
as post-operative care, that must be done during this time. Most
patients stay at a nearby hotel or sometimes with friends or relatives.
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LIFE
AFTER SURGERY
Why
can't I eat red meat after surgery?
You can, but you will need to be very careful. We recommend that
you avoid it for the first several months. Red meats contain a
high level of meat fibers, which hold the piece of meat together,
preventing you from separating it into small parts when you chew.
It can plug the outlet of your stomach pouch and prevent anything
from passing through.
What
is Dumping Syndrome?
Dumping syndrome is caused by consuming sugar or sugar products
on an empty stomach. These substances produce a high osmotic load.
Your body handles these by diluting the food with particles of
water, which reduces blood volume and causes a shock-like state.
Sugar may also induce shock due to the altered physiology of your
intestinal tract. The result is a very unpleasant feeling, as
if you are breaking out in a cold and clammy sweat, turning pale,
butterflies in your stomach and a pounding pulse. This may be
followed by cramps and/or diarrhea and it can last for 30-60 minutes.
Most people have to lie down until it goes away. It can be avoided
by not eating the foods which cause it, especially on an empty
stomach.
What
is the problem with milk products?
Milk contains a special sugar called lactose (milk sugar), which
is not digested well. This sugar passes through undigested until
bacteria in the lower bowel acts on it, producing irritating byproducts,
as well as gas. Depending on the individual tolerance, some persons
find even the smallest amount of milk or milk sugar will cause
cramps, gas and diarrhea.
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What
do I do to use the Gastric Bypass "tool" successfully?
The basic rules are simple and easy to follow:
