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Bariatric Weight Loss Surgery - What questions should you ask the surgeon?
Bariatric surgery can be a lifesaver for many people. It is also a surgery that can be life changing in more ways than just your looks.
Selecting a doctor is a very important step in the process and can affect your outcome.
I will try and include as many questions as I can. Good luck to those looking for this surgery.
Am I a good candidate?
Am I a good candidate for bariatric surgery? Some people, because of other health issues, or physical attributes are not good candidates for this surgery. Many weight loss surgery practices have restrictions on age,whether the patient is too young or old.
Many doctors do not do procedures on children, except in extreme cases.
Lucile Packard Childrens Hospital at Stanford specializes in gastric bypass for adolecents.
Types of Surgery
What types of bariatric surgery do you perform? What type would you recommend for me?
Some doctors only practice one type of bariatric surgery, while others offer several. One surgery might be better for your particular case.
One surgeon I spoke with would only do the open RNY procedure. He refused to do any surgery that was done by scope, and also refused to do lap band surgery.
Another practice I saw, they did the RNY procedure only using the minimally invasive scope, and they also offered 2 different type of lap band surgeries.
The RNY was considered the gold standard for weightloss surgery, and they still do many of these every year.
There are a few newer procedures that are gaining popularity. The Biliopancreatic Diversion, and the Duodenal Switch. These two procedures can be combined for rapid weight loss in those folks who are very obese.
How much will the surgery cost?
This type of surgery can vary widely between doctors. My quotes for the same procedure varied between 9000 and 55,000.
Insurance and Payment Questions
Do you take my insurance? If not, does the doctor have a payment plan?
Some doctors offer long term payment plans, while ofhers do not offer any such thing. Some doctors do not take insurance at all. A good practice usually has someone who is dedicated to working with the insurance company to get your procedure covered.
What are my chances from dying from this procedure?
What is your record regarding patient mortality? Some doctors are quite frank about this, If your doctor tries to dance around this question, find another doctor.
You can also check with your government's licensing board to find out about malpractice suits and mortality issues.
If a doctor has done thousands of these procedures, chances are he has lost a patient. This is not a procedure without risk. Any procedure that involves anesthesia can have a chance of failure. People have died getting broken arms set, facelifts and teeth pulled.
What hospital do you prefer to do the procedure?
What hospital does the doctor perform his procedures at. Is it covered by your insurance.
Some hospitals have special surgery rooms set up for bariatric surgery, from the table itself, to the bed in your room.
Very few doctors try this surgery at their office. Some Lap band procedures are done in their office, but usually only if the patient already has the lap band installed and needs changes made.
What kind of changes do I need in my diet?
What kind of diet will I need to eat after the surgery? Just because the surgery restricts how much you eat after surgery, there are still foods you will need to avoid. Because of the small amounts you will eat after surgery, you need to keep an eye on nutritional value of food you eat.
There are some foods you will not be able to eat without getting very sick. Generally these are foods high in sugar or fat. This can vary by what type of surgery you have.
Most doctors refer you to a dietician prior to surgery or have a dietician on staff to work with the patient.
Some doctors will make you go on a very strict diet prior to surgery.
Insurance will often not pay for the diet consultation.
What kind of mental evaluation do I need?
Any responsible surgeon will require you to get a mental health evaluation before undergoing bariatric surgery. While some might only require one visit to a mental health professional, others may require multiple visits to a psycologist.
Some patients literally go mad after this surgery. They eat themselves to death by gorging and breaking open the stitches holding the bypass together. This type of
"suicide" is what made early mortality rates for this surgery so high. This prompted the requirement for psych evaluation.
Will I need plastic Surgery?
What changes will I need to make to my lifestyle after surgery?
This surgery is life changing. In some cases, it can destroy marriages.
If one spouse prefers a chubby mate, they can find they are no longer attracted to their newly slim mate. Make sure your partner is 100% on board with what you are doing.
What are typical complications for the surgery I am having? How are they handled? Is the Doctor available to you when you are having a problem?
One doctor I talked to told me that if I had issues, go to the emergency room, and whoever was there could treat me and handle my issues.
The doctor I selected told me if I ever had a problem, go to the emergency room and he or one of his associates would be there immediately.
My Own Journey
I have been going to Doctors to see about gastric bypass for years. I have come as close as 3 days prior to surgery, only to have my insurance pull the rug out from under me.
I think I am finally rounding the corner towards the finish line.
Last year I verified that my insurance would cover the surgery. I then found out what the dr's requirements were. Two of the things on the list were not covered by insurance in my case. The first was the mental evaluation. I tried several mental clinics and no one seemed to do them. I called the weight loss surgery practice and asked if they could recommend anyone. They are not allowed to recommend anyone, but suggested that a WLS support group might have a list of mental health folks that their members had used. Tried that, and started calling numbers. The first 4 on the list told me they no longer did mental evals for weight loss. The 5th told me that he did them, but had no time to fit me in for 3 months, unless I was willing to do it on unconventional hours. He asked if I could meet him in the hospital lobby at 5 am. I told him I could do that and showed up at 5am. He wasn't there, but I waited and he made it there a few minutes later. He took me to his office and I did the testing.
I had the biliopancreatic diversion with duodenal switch procedures done on January 17th, and as of today I have lost 130 lbs.
The other thing that wasn't covered by the insurance was seeing a dietician. I called and pleaded with the insurance as many of the dieticians I called wanted several hundred dollars for this service.They said that if my doctor's office billed for it, it would be covered. I found one that worked in my doctor's building who was willing to do it over several quick meetings, and she billed my doctor, who then billed me.
That was done, and I was waiting for some time for the surgeon to accept me as a patient. Something interceded on my behalf when I found I was in great abdominal pain in the middle of the night a few weeks ago. After getting to the hospital, they found I had a stone stuck in a bile duct. The gastroenterologist saw me and said they had to do surgery to get out the stone, as the bile duct and gall bladder were full of infection. He cut my bile duct apart and retrieved the stone, then sewed the duct back. He then referred me to another surgeon to get my gall bladder removed after the infection had cooled down. Amazingly, the surgeon I was referred to was the same doctor that I wanted to do my gastric bypass.
My gall bladder surgery was about a week ago, and he told me to call in 2 weeks to get on the schedule for the gastric bypass.
Since that time, there have been a few road blocks, but now I have a surgery date in a week or so. The insurance has approved the surgery as well as the hospital stay.