I'm going to a



I'm going to a WLS public info meeting on Sunday. What questions should I ask? Are there things you wish you knew earlier?

I was at one about a year before we moved where I learned our new insurance would stop covering it the day before we started it. I have that part checked out, anyway.

Thanks for your input!














sw

If you mean it's an insurance meeting, I would find out the criteria for pre-op. Mine was BMI of 40+, some kind of medical problem on their list...mine was pre-diabetes and tri-glyserids of over 400, a list of Drs in your area that take your insurance...the more to choose from the better so you can interview them, that sort of thing.

If you are talking about Drs.....find out if they are board certified. It's not required to be certified to do the surgery but the certification process is a strict one and a good indication of training and background. Find out how many times this person has done the procedure that you are going to have and their success rate...(ie they might have done 600 gastric bypass but only 10 DS and 14 bands), do they have a follow up program.

if you are talking about the procedure itself....ask about the pre-op requirements such as...a liquid diet or a 10% weight loss...not losing below your target BMI (I couldn't go under 40). In the case of the gastric bypass, do they do or when do they do a leak test, what is the required length of the hospital stay...do they have dietian follow ups.

Knowledge is power. Arm yourself well! Good luck love!

Angela

ask about support groups. ask about nutritional guidance. followup requirements. the surgeon's complication rate. the number of patients that have died, and why.

I found this list on www.obesityhelp.com. This refers to the RNY but you can tweek it to whatever surgery you are interested in.

Print the list and mark off ones that do not pertain to you specifically. This will give you a good idea on what to be asking about.

Pre-op:
1. What pre-op testing do you require, such as blood tests, gall stone sonograms, upper GI, lung x-rays, etc?
2. Can I have these tests performed locally for insurance purposes?
3. What can I do to improve my fitness for surgery now?
4. Will I need to stop taking medication before surgery? How soon? Can I take Tylenol or Tylenol PM before surgery?
5. Can I take vitamins until surgery?
6. Do I have to do anything special the last few days before surgery, such as a clear diet, fasting, special soaps, or laxatives?
7. When will I be admitted to the hospital?


The Surgery:
8. How are the incisions closed? Staples? Stitches? Other?
9. For the RNY, do you separate the stomach pouch from the distal bypassed stomach?
10.Is the anesthesiologist experienced with heavier people?
11.When will I talk with him/her before the surgery?
12.How much of the intestine do you bypass/What is the length of the common channel?
13.What size stomach pouch do you make/How large will the finished stomach be?
14.Do you consider it to be a distal or proximal surgery? Is this only applied to RNY?
15.Do you cut the acid producing nerve to prevent ulcers?
16.Do you instead prescribe an antacid post-op?
17.Will you do a liver biopsy? Is this only for open procedures?
18.During lap surgery, are you able to "check" other organs?
19.Do you automatically remove the gallbladder and/or appendix?
20.How long will I be in surgery?
21.Will you visit my loved ones in the waiting room after the surgery to tell them how the surgery went?


After Surgery – In the Hospital:
22.How long will I be in recovery?
23.What types of pain management will you provide?
24.What are the alternatives to the pain management if what you initially prescribe doesn't work?
25.What are your standing orders re being contacted by nursing staff if I feel I need you or if prescribed pain management isn't working?
26.Will I have an epidural?
27.Will I be in ICU?
28.Will I have IV's?
29.Will I have a naso-gastric tube?
30.Will I be on a ventilator?
31.Do you insert a catheter?
32.Will I have drainage tubes in my incision or elsewhere? How many and for how long?
33.Will I need a binder and does the hospital provide them?
34.How soon will I be allowed to consume water after the surgery?
35.What about ice chips?
36.Will I eat in the hospital after surgery?
37.If I don't like the food, can I provide my own as long as it is the same sort prescribed?
38.How soon after surgery will I resume taking my regular medications?
39.How soon and how often should I walk after the surgery?
40.Will I have lung therapy?
41.Will I have a private room or will I share with someone else?
42.How long is the hospital stay? What needs to happen before discharge?
43.Am I required to stay in the hospital until I have a bowel movement?
44.Will I need to remain in a hotel near the hospital following discharge? How long?


Complications:
45.What types of complications are associated with this particular surgery?
46.Are there any reasons why the procedure may not be performed after you open me up?
47.What kinds of things could prevent/delay the surgery? Flu? Cold?
48.If this is Lap surgery, is there any situation that might cause you to switch to an open?
49.What type of complications may I have post-op, such as vitamin or mineral deficiencies, hair loss, gall stones, infections, hernias, ulcers, etc?
50.Have you had any patients die on the table or post-op due to complications? Please explain:

Recovery from Surgery:
51.Typical discharge instructions?
52.Follow-up care? Can a local Dr. provide this? What sort of Dr.? How can he/she communicate with you about my particular long-term needs?
53.How will I have to eat immediately post-op and down the road?
54.Will I have problems with diarrhea or gas post-op? How can this be treated?
55.Will I vomit a lot?
56.Recovery time for lap? for open?
57.What kind of post-op care/help will I require once I go home and for how long?


Long-term Post-op Life:
58.How much weight should I expect to lose and how fast?
59.Should I expect to regain any of the lost weight?
60.Will there be medications that I can no longer take post-op, or medications I won't absorb normally?
61.Will I get sick eating sugars, natural or otherwise, or from eating fatty foods?
62.What percentage of calories and fat will my body absorb post-op?
63.How many calories and fat grams should I eat post-op?
64.How many grams of protein will I need to consume each day?
65.Do you recommend protein supplements?
66.Are there any specific foods I should not consume post-op?
67.What supplements and medications will I be taking post-op?


Describe long-term follow-up:
68.What about pregnancy post-op?
69.How often should I get weighed?
70.What types of exercise do you recommend and at what stage post-op?
71.How can this surgery affect health problems I might develop later? cancer (treatment), need for stronger meds for arthritis, osteoporosis, etc.?
72.Is there any risk of cancer or other problems in the bypassed portion of the stomach?
73.How will these be detected post-op?
74.If it came down to life and death, can this surgery be reversed?


Personal Questions:
75.Where did you receive your training?
76.How long have you been in practice?
77.How many of these surgeries have you performed?
78.How often do you perform this surgery? (Per week, month, etc.)
79.What percentage of your patients receiving this surgery have had major complications? What kind? Why do you think these happened?
80.As above, what percentage have minor complications? What kind?
81.Is there anything I can do to prevent these?
82.Can I speak to some of your post-op patients?


Financial Considerations:
83.How much does the surgery cost and do you accept my insurance?
84.Do you think I will have problems getting insurance approval?
85.Will you help me in the appeals process, if necessary?
86.If I have to self-pay or pay a portion of the costs that insurance doesn’t cover, will you accept payments?
87.Do you have a sliding pay scale?
88.Do you require a deposit? How much?
89.Does your fee include all aftercare? For how long?


Communication:
90.I'm concerned about negative comments I've heard on-line about the communications skills of your office staff. What can I do (without being offensive) to make sure my paperwork is handled in a timely manner?
91.May I call the office to confirm that paperwork has been sent to my insurance company?
92.What should I do if I feel my needs are not being met?
93.How should I contact you if I have more questions?
94.Next step toward insurance approval? Steps after that?

It was presented by the doctor-she talked to us for over two hours! She has great information about why some people get fat and can't lose weight (survival! Hellooooo, body! I can survive a loong time with out food, here-you can stop hoarding calories, now!) She gave detailed descriptions of the two kind of surgeries she does and why she won't do others. We got to handle the lapbands -she's doing two kinds now. She told us about some clinical trials they will be starting. One is called VBloc which involves putting electrodes on the vagals (sp?) nerve which sends "stomach full" signals to the brain. You carry something around to activate it to feel full so you won't eat but you can take it off when you want. She also gave us her mortality stats-very, very low. The hospital she works from has a wing dedicated to bariatric surgery with private rooms and free facials! The hospital reviews I've seen on other places are pretty unfavorable.

I submitted my info packet and I should get a call in a week or two to set up my first appt.! I don't have to do a 6 month diet as required by some insurances. The biggest problem I foresee is medically supervised diets.

I asked the office staff there if it she thought, based on her experience,if it was possible to have insurance clearance in time to have surgery in June.
She said very possible. So, here's hoping and praying...

wow - you sound calmer now that you've met the doc and gotten some information. that's wonderful!!!!

that gastric pacemaker - one of my friends had it done as part of a clinical trial, oh, about 8 years ago. it didn't work, and there were some problems. the clinical trial stopped, and i think the company went back to the drawing board. i've hear that there have been some improvements, but i really don't know more than that.

sooooo, how are ya feeling???!!!!!