I have an overall question

I have a question for everyone. 

Over the past several weeks since I joined OH and have been reading and posting on the message board, I've noticed some things that puzzled me and I wanted to ask about.

I realize that all hospitals and doctors do things differently, but one thing I have not seen is anyone talking about an extensive pre op program.  Unless everyone has just put that part behind them and at his point had become overwhelmed by their surgeries being so close and having to deal with the emotions and recovery part of it.  

Anyway.... when my husband and I made our decision to start down the road to a new life, the hospital we chose, required we attend a 6 month pre op program. Which actually ends up being about 9 months all together. And EVERYONE must go through the pre op program. There are no exceptions. This program consisted of first attending an informational meeting, then 6 months of group classes and support group meetings, appointments with the dietitian, the psychologist and monthly appts with the Baratrition. The psychologist and dietition are at our disposal at all times for assistance. If we had questions or needed help, one phone call or email at just about anytime night or day would get a quick response.

Our hospital also has a wonderful post op program. Our surgeron is only a call away if needed for any problems. My friend who had the surgery the same day I did, had a problem with one of his incisions getting infected and he called the surgeons office and Dr Boorse called him back ASAP and had him back up at the hospital within the hour to take care of the problem.  They also have post op support group meetings and as always, the psychologist and dietition are at our disposal at any time.

Another thing I noticed is all these poor people who are put on this 2 weeks of liquid diet just prior to surgery and then I hear so many saying how they are worried or upset because the doctor wants them to lose a specific amount of weight during that time. Talk about putting these patients under extreme psychologial stress. Like they aren't already under tremendous stress just dealing with the upcoming surgery. Our surgeon had us do Atkins Diet for the 2 weeks before, not so much to try to lose weight but to shrink the vital organs (liver mainly) that they had to work around. The issued of losing weight was dealt with all through the 6 month pre op program. There was enough pressure on the patients during that time to lose weight let alone trying to make them lose a specific amount of weight 2 weeks before the surgery. I can't begin to imagine the hell this puts the patients through.

Please don't get me wrong, I'm not questioning the doctors or hospitals for there ways of doing things but I was just curious as to how programs are done so differently. Although it seemed to take forever to get through all the required programs and meetings and classes, it really prepared me well for the surgery and life after.  And the ongoing post op support group meetings are fantastic. Pre op patients can also attend these meetings so they can talk to post op patients.

If anyone would care to share their pre op expreiences and what they were required to go through I would love to hear about it. I'm just curious to see the difference.

Thanks,

Take care,
Kim

Hi Kim,
A lot of your pre-op needs are based on insurance requirements, the remaining is provider or surgeon preference.  My insurance didnt require all of that, but my friends did.  Kaiser requires about a year of things prior to WLS.  I have Kaiser & Blue Cross PPO and my blue cross had very little requirements, but there are people with different blue cross policies *****quire the 6 month.  I didnt want the extensive program for a plethora of reasons, primarily I wanted to start losing asap.  The classes are very educational and a wonderful benefit.  My NUT, Psych, & Surgeon are jsut a call or text away always and have given me soo much info that I havent ever had to call other than to say thank you.

As for the difference in time, I had my labs in the end of Nov. 08 and could have had a surgery date for mid december but my surgeon had back surgery so I am now 9 days postop.  We have meeting in several different sities but the closest to my house meets twice monthly and my 1st one will be 2/6.  I did have the 2 week liquid, cheated a few tmes, but all was fine, it prepared me to eat differently so that was good for me although I hated it.  I didn't have to lose any amount of weight at all just shrink my liver.

My case nurse calls be about weekly to check my weight, diet, emotional status and to see if any questions have come up, ask about my incisions, etc ... she & my psych has emailed and texted me encouraging messages and emails ... 

So it really is a combo of ins requirements and surgeon preference, I think that it is nice when what you have works for you and it sounds like we have been blessed with what we like!  Congrats to you Kim! 

Thanks for your reply. 

It is just interesting to see the differences.  I also have the Blue Cross PPO and I don't think it was so much a requirement of MY insurance company but I know other insurance companies did require it so I guess LVH made up their 6 month program and requires everyone to go through it regardless of the insurance requirements.  I think it was a good learning experience though.

Take care and hope all is well with you.

Proud to be a LOSER !! .... LOL

Kim

Absolutely, you are right it is not the company at all.  The employers structure the policy and determine what they want to offer to their employees, which is why I say the insurance & the surgeon preference.  There was a Dr. Khalili in my area and he had a program like that and was a par prvdr. I work with health insurance daily & have to explain how the employer chooses what they want to offer ... so I think we are in agreement ... never thought I would say that I am proud to be a loser but I must join you on that too!

Hi Kim,

I think so much of the pre-op & post-op program depends on the insurance and the hospital.  In my situation, originally I wanted to have the surgery done closer to home at a hospital that has a bariatric surgical program.  I am quite certain the post-op and pre-op would have been much more extensive and helpful, much like you described yours.  My insurance would only cover the cost if I went to UCSF or Stanford, which are both teaching hospitals.  The reason for this is because it is much cheaper for the insurance/network to have it done at one of these two places because they do so many WLS surgeries.  I sort of think of them as churn and burn, get em' in and get em' out programs.  I liked my surgeon at UCSF BUT, I think their post-op instructions left alot to be desired.  Fortunately, I am persistant enough to do the research and ask the questions and my PCP has been wonderfully supportive and informative.  I have had NO problems or issues post-op and did fine pre-op with the 3 slim fasts and the clear liquids for a week.

Glad you are doing so well and hope you'll keep in touch.

Barb

I think everyone is right about the fact that insurance dictates what will be covered and what is required.  For instance, my bariatric surgery practice required a couple of meetings with the nutritionist before surgery, but my insurance did not cover all of them.

I started the process offically in April of 08 with a required informational meeting.  My practice offers monthly meetings for pre and post op patients.  Unfortunately, my practice is over 1 1/2 hours away from my house.

I went to the Adirondack Medical Center to meet with the Bariatric practice every month prior to my surgery on 1/20.  I went through the normal psych eval, nutritionist, labs, weight monitoring, etc.  They kept close tabs on me.

Luckily, my insurance didn't put me under the pressure of requiring a certain amount of weight loss prior to the surgery.  I didn't have trouble losing weight at the end, however, because my surgery group did require a 9 day pre-op liquid diet.  I was more than happy to comply.  I figured, if I can't do it now then what will happen when I have to do it after the surgery?  It really helped me prepare mentally and physically for the surgery.  The main reason for the liquid diet was to make the surgery safer. 

What also put me at ease was the expected hospital stay.  I had surgery on Tuesday 1/20 and my expected (and realized) discharge date was 1/23.  I know some people who have had lap RNY had shorter stays.  I'm so glad the practice gave me that time to recover in the hospital. 

Post op follow up will be similar.    I have my first appt on 2/3 and the next on 2/23.  I plan on having the Adirondack Medical Center/Bariatric Surgery Center in my life for quite some time.

I wouldn't have had this surgery without that kind of pre and post op care.