How often did you have to go to the medical center before surgery?

i live in a rural area right now and also have a pretty demanding job where I can only take so much time off. I am overwhelmed by everything that is necessary before WLS, especially since I live over an hour away from the hospital where I would be having surgery. I have a few questions.

Were you able to work with a dietitian not affiliated with your center? I have been seeing a good one locally that has helped me a lot.

Did you have to attend more than one nutrition class?

Was a support group required? I know many of you will say this really helped you, but aside from not having four hours to drive in and attend a weekly support group in addition to everything else that is necessary, I am extremely introverted and this sounds like absolute torture to me. I would rather see a local therapist.

To be honest, having to make the drive in weekly and my massive social anxiety about attending a support group would probably be a deal breaker for me.

Insurance policies have a set of requirements that you have to complete. And surgeons and hospitals have a set of requirements as well. I have seen hundreds of different combinations that folks had to follow, both before and after surgery. You really will need to find out what exactly yours require.

There will be multiple trips, there's just no avoiding it. I know it's burdensome, but it's all for your safety, as well as success.

Every plan has different requirements, plus you have to deal with your insurance requirements too. I?m an hour from my center and travel for work at least half of every month so I know how you are feeling scheduling wise ? it?s overwhelming but impoetant to do all the pre and post follow up if you go this route!

I did want to comment on the support group aspect because that was one of the things that I was skeptical on. My program required 1 Support group session before surgery, they also required an 8 week ?change? program, and my insurance had the 6!month requirement. I did the single support group session as a check the box exercise but I found that I liked it more than I thought I would and I have dropped in on it a few times since then (it?s a two hour session every other month).

In talking with people at the group (it?s open to everyone, not just people that were in the same program) some programs allowed them to count online support groups like OH to meet the requirement - I think there was a ?participation requirement? so you might want to ask about that!

Good luck with your process and moving forward!

I had 6 monthly pre-op visits with my surgeon, nutritionist and PCP (4 at weight loss center plus 2 with my PCP locally since my insurance required 6 monthly medically supervised visits about weight loss). There was also a pre-op appointment just before surgery at the hospital. In addition, I had 3 required support meetings. My weight loss center was 90 minutes away and I visited that site 8 times prior to surgery. Then there was the surgery. Post-op I had appointments at 10 days, 3 months, 6 months, 9 months and 1 year, then annually thereafter.

Even though it was 90 minutes away, it was well worth it. At the support meetings, I didn't have to talk if I didn't want to (I could just listen).

Every center is different and of course your insurance dictates a great deal of what will happen. I visited my surgeons office 3 times between the initial consult and surgery day (which was over the course of 4 months). I was not required to participate in any support groups, but I did have to go to a pre-op class (which was one of the 3 visits). They also record the support group sessions so you can listen to them online, which I liked a lot. Post-op I've seen my surgeon 4 times in the 8 months since surgery. Overall it hasn't been too demanding, and of course it's all been 100% worth it.

Good luck with everything!

My insurance required a 6-month nutrition and exercise program with a ?significant face to face component?. So we met 6 times?once per month (once or twice I could not make it to the office, so we did our meeting on the phone. My insurance also required a psych evaluation, which was a one time thing. I also had a surgeon requirements (not an insurance one) to get cleared for the surgery?this included a cardiac clearance (ekg and stress test), and a pre-surgical clearance workup from my PCP. Then, I had to get an egd so my surgeon could see what they were working with. Also, I had to get two sets of blood work?-one pre-egd and one pre-surgery (you can get these done at just about any local lab, eg Quest Diagnostics). Then, once approved for a surgery date, I had one more meeting with my nutritionist to talk about pre and post surgical diets (and get packets), and during this same appointment had another session with the surgeon where we again went over everything. Lots to do, but no support group requirement. And, I did this over a year+, many do it all in 6 months. But also know that follow up is crucial, and after the surgery, you will need to see your surgeon for follow ups and you will need to do labs to make sure your vitamin levels are ok.

Talk to your surgeons coordinator and insurance to figure out the exact requirements. I?m sure there are solutions to be found.

I know now it sounds overwhelming, but when you space it out, it?s doable. It sounds like you have some work and geographical challenges. If you are in fact obese, perhaps weigh the geographical and work challenges against the day to day challenges of being obese. Could an investment of time and hassle now yield benefits that would help your quality of life moving forward? Maybe that demanding job gets easier to manage? If you decide that surgery is not for yiu, that?s okay, too. Good nutrition and exercise can still raise your quality of life. Good luck with whatever you decide.

The insurance requirements are usually fairly general and can be satisfied by most any qualified professionals, so your current RD should be fine. Individual WLS programs can be quite varied and may have more onerous requirements for dealing with their specific people, but there should be some flexibility for non-local patients. That said, some hospitals that don't have much competition can be pretty fussy about using their facilities - patient/customer service is often forgotten when there is isn't a competing program in the area. Talk to their reps and see what can be worked out to fit your needs. The couple practices that I have worked with both deal with a fair number of travelling patients, so they are set up to accommodate their needs. While the program that I worked with had a local support group, I only had to go to their office and hospital for pre-op tests and education the day before surgery.

If your "local" center is not that accommodating, you might find that a program that is six hours away is more convenient than the one that is four hours away if they understand the needs of travelling patients; it's worth looking into if push comes to shove.

Thank you all so much for your thorough and thoughtful replies! I think I meet what my insurance requires because I called them already. I have been seeing a dietitian monthly for over five years. The rest of it seems challenging, but doable.

I guess I will just have to wait for the in-person orientation when they tell me what is required by the center. There is another place in the same town that has a video orientation and says they have accommodations for out of town patients, but they are not yet a "center of excellence" and my insurance requires that. I guess if this place doesn't work, I might wait until the other also has that designation.

Thanks again for your time and support!

Roselane,

These are questions you should be discussing with those on your surgical team... Part of these requirements you may have already ful- filled by the treatments you have had in the recent past, even by your personal physician-and those to whom you are referred locally. especially if you have been weighed and this Doctor is on board with your quest for healthy weight loss...

I lived more than 90 miles from surgery and Physicians office. At that time it was over 2.5 hours driving time. I did not have a diet class, but a private counsel with a dietician was part of the rotation thru the clinic each time before surgery., and I had 2 post op visits before I lost my insurance. I could not lift for 6 months, and I knew once I had surgery would not be working for that long.

I got the copies of my surgeons notes, and complete medical records, so any Doctor i need to see has a medical history of the procedure I had and can judge the impact on any future medications..

For at least one week prior/sometimes would need to do a 2 week diet diary. The evaluation of diet diary, was one way the evaluation was done on metabolism realities.

I had an Open abdominal surgery that turned out to be 10 procedures, because of other health issues I had ,and surgeon fixed while he was there...My appendix and gall bladder( was bad) were removed, ovarian cysts on both sides and a huge bunch of fibroids,and endometriosis was found and all possible was removed, in addition to the pouching banding and resections done in what my surgeon called The Memphis Gastric By-Pass. Basically was an RNY+ (small bowel resection-and much of my Colon was removed.) The remainder of my stomach is fitted with a stoma, so that in an emergency it can be accessed for feeding tube. The old part of my stomach has no inlet, but makes digestive juices that are shunted down for beginning of small bowel digestion.. I got to goal, actually below initial goal. still am within 15 lbs- 23 years later.

Yes, even with the issues i have now would definitely recommend to those who are unable to maintain a weight loss. It gives one a tool and a mechanical control. I do have some issues and they are all treatable with over the counter nutritional ...including anemia( which i use buffalo, beef or pork dehydrated liver capsules to treat. I have no intrinsic factor and it is in only one food -liver..Taking 2 or 3 of these every day enable me to absorb iron from other foods.I have added K2 o my regimine to help manage magnesium and calcium stores.Other than that and changing the type of calcium to calcium citrate for better absorbtion..am taking the same things Dr reommended years ago.

This Doctor is the one who wrote the book on giving nutrition thru the veins (TPN) It is still used for source teaching( Dr's) material today.

Some skills you need to build on are measuring all meal and fluid amounts accurately, now.

There are some visits that can be combined at same time you see the Surgeon for initial assessment... generally you see a nutritionist in addition, and possibly a psychiatric consult...Just let the Dr's clinic staff know you are traveling very far.,and request for them to set you up with all appointments possible in one trip,for minimal trips in.

You have some great advice here.... Talk to your team and see if you can do some of the requirements locally. I have seen surgeon's offices work with those that have transportation issues.

In my experience it's not where you do it, JUST DO IT! Trust me, all of this is key for getting to goal and long terms success. If you don't deal with the issues that lead you to this point in life, surgery will not work for you. That may sound harsh but after 14 years trust me I see it over and over again. I tell people you have to get it right between the ears before you re-arrange your plumbing. Support group is key, but again see if your surgeons office has an alternative. I had to drive over an hour for my support group but it was only once month and it was key to my success I told myself if I added up all the time I drove to the store for junk food and time I spent driving to the fast food places including Krispy Kreme donuts it was nothing compared to an hour a month.....

YOU GOT THIS! We are here for you all the way