St. Joseph Health System
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Frequently Asked Questions

General

Q1. Am I a candidate for surgery?
Answer: If your BMI is 35 or above you could be a candidate for surgery.  Please use our BMI calculator to figure out your BMI.
 
Q2. Where do I start with the process?
Answer: Most patients have a lot of questions about the type of procedures as well as the risks and complications.  The first part of our process at St. Joseph’s is to attend a seminar, put on by one of our Bariatric surgeons.  Seminars are FREE and last about and 1 ½ and give you the opportunity to hear the information first hand as well as have your questions answered.
 
Q3. Who should attend the seminar with me?
Answer:
We like to recommend that you bring someone who will be your support person throughout your weight loss journey.    

Preparation for Surgery  

Q2. What can I do before the appointment to speed up the process of getting ready for surgery?
Answer:
1. Attend a seminar
2. Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
3. Bring any pertinent medical data to your appointment with the surgeon - this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
4. Bring a list of your medications with dose and schedule.
5. Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.

Q4. What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
Answer: Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient's weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending gastric bypass surgery if it is otherwise appropriate, but those conditions will make a patient's risk higher than average.
 
Q8. What are the routine tests before surgery?
Answer: Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), Urinalysis, and a Chemistry Panel, which gives a readout of about 20 blood chemistry values. Often a Glucose Tolerance Test is done to evaluate for diabetes, which is very common in overweight persons. All patients but the very young get a chest X-ray and an electrocardiogram. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or psychiatric evaluation, may be requested when indicated. 

Insurance Issues  

Q1. How can they deny insurance payment for a life-threatening disease?
Answer: Payment may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity."
Insurance payment may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments - such as dieting, exercise, behavior modification, and some medications - are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.

Q2. What can I do to help the process?
Answer: Gather all the information (diet records, medical records, medical tests) your insurance company may require, before your consultation.  This can help to reduce the time it takes to navigate through your insurance plans process.

Q3. Why does it take so long to get insurance approval?
Answer: After all pre-operative tests have been ordered and results have been received your surgeon’s office must mail or fax your information to your insurance carrier.  Insurance carriers time frames vary from 1 to 4 weeks to respond to your surgeon’s request for the surgery.

Surgery  

Q2. How long do I have to stay in the hospital?
Answer: As long as it takes to be self-sufficient. Although it can vary, the hospital stay (including the day of surgery) can be 1-2 days, but is usually 24 hours.
 
Q3. Will I have a lot of pain?
Answer: Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about other pain management options.
 
Q4. How soon can I drive?
Answer: For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes 7-14 days after surgery.
 
Q5. How soon will I be able to walk?
Answer: Almost immediately after surgery doctors will require you to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.
 

The Hospital Stay  

Q2. What should I bring with me to the hospital?
Answer: Personal toiletries (comb, toothbrush, etc.) and an outfit to change in to before going home.  A hospital gown will be provided by the hospital during your stay, but some people prefer to bring their own. Choose clothes for your stay that are easy to put on and take off. Because of your incision, your clothes may become stained by blood or other body fluids. Other ideas:
-reading and writing materials
-crossword and other puzzles
-bathrobe  

Life After Surgery  

Q2. If I continue to smoke, what happens?
Answer: Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection, and interferes with blood supply to the healing tissues.
 
Q3. Will I lose hair after surgery? How can I prevent it?
Answer: Many patients experience some hair loss or thinning after surgery. This usually occurs between the fourth and the eighth month after surgery. Consistent intake of protein at mealtime is the most important prevention method. Also recommended are a daily zinc supplement and a good daily volume of fluid intake.
 
Q4. How can I know that I won't just keep losing weight until I waste away to nothing?
Answer: Patients may begin to wonder about this early after the surgery when they are losing 20-40 pounds per month, or maybe when they've lost more than 100 pounds and they're still losing weight. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition.
 
Q5. Does hair growth recover?
Answer: Most patients experience natural hair regrowth after the initial period of loss.

Q8. Will I have to change my medications?
Answer: You will need to keep in close contact with your primary care doctor regarding any longer term medications you are currently on.  Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Change in dosage may be required with weight loss but will need to be discussed with your primary care doctor.  Two classes of medications that should be discussed during your consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.
 
Q10. Will I be miserably hungry after weight loss surgery since I'm not eating much?
Answer: Most patients say no. In fact, for the first 4-6 weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous "eat everything in the cupboard" type of hunger.
 
Q11. What can I do to prevent lots of excess hanging skin?
Answer: Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure.
 
 
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