Question:
HELP! I'm going to broach WLS with my PCP tomorrow

How should I prepare for this first meeting with my PCP about WLS? I'm going to see him on the auspices of the pain in my knees from arthritis (which is valid) and then bring up my WLS if he doesn't. Should I ask generally about assistance in losing weight or go right for the jugular? *Hee hee* It might help to know that this is my first ever appt. with this PCP on this plan so I have no way of knowing where he would align himself on this issue. I want to do everything I can to get his support and not alienate him. TIA!!    — antiques55 (posted on April 21, 2003)

April 21, 2003
Two things. First of all, I have been with the unsupportive PCP trying to jump through the HMO hoops for WLS. I finally gave up, found a supportive PCP but also went with my PPO insurance so I didn't have to have PCP approval (although by that time I did have it). So check with your surgeon and insurance and make sure you absolutely need PCP referral. Ultimately I didn't need it for my insurance and for the surgeon I picked, but other surgeons I spoke with wanted a referral from my PCP. Secondly, if you do absolutely need the PCP involved just let him know up front this is something you've researched and would like his feedback/opinion. This will tell you if he is supportive, and if not, find another one. I was devastated when my first PCP FIRED me as a patient for broaching the subject. I posted on here about it and a very nice person from my area read my post and made a recommendation (I've since met her in person-Hi Elizabeth!) to the *great* PCP I have now. While I didn't need his referral, he gave me medical clearance for the surgery (after speaking with me in length about it) and he and my surgeon work so well together and I am grateful for his involvement in my aftercare. You can also call surgeons in your area (if you have one or two in mind) and find out who refers to them. It takes a bit of work to become "savvy" in this area and working with docs, but if you hang out on here some, you'll be up to speed in no time. If I had one piece of advice for anyone starting out it would be: if you have researched this and it is what you really want and if you qualify (BMI over 40 or over 35 with serious comords) don't back down, don't be intimidated and don't take no for an answer.
   — susanje

April 21, 2003
Hi there. Good luck with this first step. Iwould let the PCP know up front what my intentions are. I had zero luck with my long time PCP and had enough of the humiliation that I felt I suffered under his care. I decided I needed to make this happen for myself and even though I was an emotional mess when I first met i\with my new PCP I was upfront with him. I laid it all out there and told him that no I wasn't interested in taking drugs that would make me potentially mess myself in the grov\cery store if I ate something wrong for lunch. I had tried alot of diets and had actually had limited success with them and showed him in my medical file the progression of things. I had lost down to 250 from 300 and maintained 40 lbs of that loss for 2 years but I was beginning to creep back up again and was terrified at where I was going to end up this time. He was very helpful and supportive. He had 2 patients that had had this surgery while under the care of other Dr's and he was doing the long term post op care. I was his first case to start the process in his care. He now has several other patients who are "checking into" and doing research on this option. Good Luck to you and if you don't find what you are looking for in this doctor keep trying you don't necessarily "click" with them all and they all have different philosophies on weight issues and weight loss options. Many don't even look at this as an option and that is exactly what it is to me. An option and a darn effective one at that. Keep trying if you don't find what your looking for with this PCP. There are alot to choose from. Penny :-) 300highest/257PCP/243preop/167now/goal ??? 140ish (5'3.5") LAP RNY 7/31/02
   — pcollin4

April 21, 2003
I agree with the other posters. It's better to be up front and open about your desires. That way, you will know early on how he feels about the surgery in general. Since this is the first visit to this PCP, have you already had your medical records transferred from your previous PCP where you medical conditions (if any) are documented? If not, I would try to get those records to him ASAP. If necessary, pick up a copy and take them to him yourself or if you've moved, ask your previous physician to mail or FedEx them. Good Luck
   — Carolyn M.

April 21, 2003
First off, you have gotten some wonderful advice in the post above and I cannot not add much but support. I can tell you that I just met with my PCP last Thursday, and it did not go well. I do not usually see this doctor (I always go to the nurse practitioner), but thought since this was such a big decision I should actually se the doc himself. Well for me it was a big mistake. He is totally against WLS. Thankfully I went in very well informed. He did say that "With a little diet and exercise you can take off this extra weight". I got very defensive, and finally did get the referral. I am still waiting to see if it gets approved. Good luck too you, and try not to get discouraged if the outcome is not what you want.
   — mytime

April 21, 2003
Here is what I would say: My knees are bothering me and I realize that it is aggravated by my weight. Here is what I have done in the past to lose weight. (list your efforts). I also realize that WLS is the "ONLY documented effective means of achieving a healthier weight"--this is a direct quote from Dr. Louis Flancbaum, a noted bariatric surgeon in NY. I would appreciate a referral from you to see a bariatric surgeon. I have done extensive research on the subject... BY then, he should have given you some indication as to his level of knowledge in this area, and perhaps you can educate him if he has questions. Good luck. Don't be closed to any other suggestion he may have for you to try while you wait for a surgery date.
   — Dana S.

April 21, 2003
I did not have any trouble with my PCP. I had decided to ask her what her opinions were on gastric bypass surgery at an appt. I had. But before I could bring it up, she asked me if I had ever considered it! She has been wonderful through the whole process. I could have not asked for a better PCP. Dr. Patricia Landry, Easley, SC. Kim 02/04/03 -76#
   — Kimberly K.

April 21, 2003
Thank you all for your great advice. Unfortunately I don't have time before this appointment to gather copies of my medical records to take along, but I plan on requesting them soon. I was at least able to get my last BP reading and cholesterol numbers from my previous PCP to have with me. I am absolutely positive that I need the referral but appreciate the suggestion that I check. I have prepared a list of complications I have had in the past (discectomy, gallbladder surgery, arthritis, back pain, bursitis) and the names, addresses and phone numbers of the specialists I've seen. I also prepared a dieting history for the last 25 years. It's not extraordinarily detailed. I know what methods I've tried but I can't remember exactly when I tried them. I also had to guess at what my losses (and subsequent re-gain) was. It's sad to see all the things I've tried that have failed. The one thing that was probably the most effective for me was fasting and exercising like a demon way back when I was 19-20. It was also the least healthy thing I've done, if you don't count Phen/Fen. I have also printed out a list of the risks of surgery and will look them over tonight so I can go in sounding informed and that I've thought this through. So, wish me luck and I'll post back what happens!
   — antiques55

April 21, 2003
I agree with the other posters. I started researching this option before meeting with my pcp, and was nervous about what she would say about it because she is a D.O. and usually relies on more traditional, natural remedies to problems. She has, however, been my doctor for almost 10 years, and knows the ups and downs I've been through, and when I approached the subject, she said, "Yeah, I think you've finally reached the point where you need to do something more drastic." Boy, was I relieved! Since my insurance doesn't require a referral, she told me to just schedule an appointment with someone in my network and let her know what info the insurance required and she would supply it. Hopefully, your doctor will be as open-minded as mine was, especially if you give him/her a list of the methods you've tried already. Good luck!
   — Moysa B.