Differences in pre op preparation, and teaching. Across the country

I recently met a woman who said she had the RNY August. In Florida. We were on vacation . I was curious as to her preparation for surgery and present dietary restrictions.  She only saw the surgeon twice, she did not have to see any other specialists, and was surprised that I had. 6 month preparation required by my insurance nice company, whi*****luded cardio,pulmonary, psychologist and psychiatrist, upper endoscopy, sleep apnea study, and some others I can't recall

i had be on liquids for 2 weeks pre op to shrink the liver . I had surgery on  Oct 4 2011 and she had surgery in August 2011. She had no food restrictions pre- op? 

Pat the time I met her , I had lost about 85 pounds, she 40. She was eating and drinking like she didn't have surgery - soda and beer with dinner, normal sized portions. I kept asking her about her dietary restrictions if any and how often she saw the surgeon. She mentioned that she didn't have to go back, but was concerned because she had gained back a few pounds. 

She said she couldn't have tolerated the surgery if she had to eat the way I did , small portions, no drinks with meals. I tried to explain that was the reason I was still loosing and maybe she should consider another doctor. 

What I failed to mention earlier in this post, it that I am a nurse, and see what physicians do a little differently than the general public. 

It took all I had to not give the woman unasked for advice.

what would anyone else have done?

I would have focused on myself and not given her unwanted advice.

When I had my surgery many of the people in my group who also worked for General Motors were on insurance options that required no preparation at all.  They could come into the surgeon's office on Monday for their initial consult and be scheduled for surgery the next Tuesday.  The surgeons made a judgment call as to whether they were healthy enough for the surgery and there were many who had the quick fix.  Getting a lap band took ten days from initial appointment to hospital discharge. 

Patients with that plan were required to go through a bit more pre-testing for RNY, but still a very quick process.  I was irritated that my insurance required six months of diet and exercise first.  I had to meeting monthly with the NUT so she could analyze my food records.  I had to send Aetna my printouts from Curves that showed my exercise days accomplished, weights and measurements.

 Then I had to endure the stress test at the heart clinic, do a sleep study, have some kind pre-op scope, get treated for H. pylori, take nutrition classes, attend support classes and also take a class on the emotional aspects of the surgery.  I had to go through meetings with a psychologist, take tests a his office and get an approval letter from him.

For about six months, a good portion of my time and money was being used for surgery preparation.  I kept wishing that I had not chosen Aetna as my provider that year.  Aetna assigned me a case worker who called weekly to check on my progress and be sure I was following their rules.  My case worker worked with the bariatric surgery center to make sure all the i's were dotted and the t's were crossed.  When they finally submitted for surgery, it still took six weeks to get my approval from Aetna.

After surgery, my case worker continued to follow up with me.  Aetna had a post-op plan and tracked my post-op appointments and my labs and of course, my weight loss.  That continued for the first year after surgery.  I could have continued that counselling if I had wanted to.  In addition to the over-the-phone therapy, they encouraged me to talk to a therapist is I needed more help.

I believe that all of that preparation and guidance made me very successful long term.  At our support meetings, I saw many of the quick-fix lap band patients lose about 30 pounds and then gain it back.  They talked about eating pizza, living on ice cream, smoking, and vomiting all of the time.  After a while our center separated patients and had support meetings at different times for their lap band patients and their RNY patients.

I know that all of the pre-op and post-op guidance that I received made a big difference in how surgery has worked for me long term.  The tool itself was just a small part of the process of changing how I ate, and how I handle food now.

I would never give anyone advise in a situation like you were in.  But I am thankful that my journey was different than theirs.

I'm a nurse too! Educating patients is a major part of our jobs and you know as well as I do that being a nurse isn't something you turn off when you clock out, right? :) Friends and family are always soliciting medical advice so it becomes second nature to us to educate those around us within the scope of our practice. When strangers discover in the course of conversation that we are in the nursing field, often the next thing out of their mouths is, "Hey, can I ask you a question..." followed by some type of description of an ailment they have had for xyz number of days/weeks/years. This is why a nurse is always on duty, LOL! With that said, my rule of thumb is unless solicited for advice I do not say anything UNLESS the person is in immediate jeopardy at which time I strongly encourage them to see their doctor or go to the emergency room. Like you my "radar" often goes off when I know that the care the patient is receiving is questionable. You did the right thing by not giving unsolicited advice. Patients have a duty to be informed and clearly this lady felt confident she was well enough informed to have the surgery and follow her surgeon's guidelines, if indeed those were his/her instructions. I doubt anything you would have said further would have made much of a difference.

Yep always amazed at the differences in pre-op AND post-op guidelines... probably more so post-op. Pre-op while it's nice to have that time to mentally prepare for surgery, get in the zone and being on this side of the knife I understand the preparation benefit... there is a push to eliminate pre-op diet requirements and I tend to agree with axing those. I mean most of us (and that can be determined on a case by case basis) have made many many many (did I say many) attempts at weight loss throughout the years. Delaying wls to patients whose health may suffer over those 6-12 months seems a shame and often the programs required aren't covered by insurance, added expense. Seeing a therapist for a few months prior and post op would make WAY more sense to me. Making someone diet, something that didn't work before very well doesn't.

The liver shrink 2 weeks I get... nicked liver does not sound pleasant and I understand it cuts the time of the surgery down by several minutes if you have a easier maneuvered around liver... so less time under is always good. As for me... I had open RNY so it wasn't required and though I chose to make some lifestyle changes that last month before surgery. I could eat till 24 hours before. I was so nervous I didn't.

As for the post-op eating guidelines, well I might have brought into the conversation the why's of some of the dietary changes I've made or how interesting it is the difference in our protocol (which might prompt her to ask some Q's of her Dr) who know maybe he does have a protocol and she missed that discussion ;) but as the above posters said unsolicited advice rarely goes well.

~Michelle "Shelly"

It's a 12-step principle to practice the law of "attraction" rather than "promotion".  Never give advice, let people come to you and ask you how you got what you wanted, and then lay it out for them.   

You did the right thing! 

I think that this is a good example to those who are considering WLS to do their homework before choosing a surgeon.  

I chose a doctor over three hours away because of his medical reputation, and both pre and post op program.  If you are serious, you want the best program possible.  I was happy to meet all of the many, many requirements necessary before they would schedule surgery. 

Six months out and I've had six post op appointments and know that they will know if I'm not following the rules.

I feel for the woman you met as she is not getting her money's worth from either her surgeon or her tool. Unfortunately, she may end up having problems later on.

Thanks to all who took the time to read and comment on my post. It looks like most felt as I did. Again, thanks.