|
Here are some frequently asked questions about having weight loss surgery at Good Samaritan Hospital. As always, please check with your healthcare provider to determine their practices, guidelines and what they recommend for you. If your questions are not answered below, call (513) 862-4957, or email our team.
The Good Samaritan Weight Management Center
Paying for Surgery
Preparing for Surgery
Surgery
Life After Surgery
The Good Samaritan Weight Management Center
What weight loss surgeries are offered at Good Samaritan Hospital?
The majority of weight loss surgeries performed at Good Samaritan Hospital are Roux-en-Y gastric bypass procedures. These are done both as an open surgery and hand-assisted laparoscopic surgery. We also offer laparoscopic adjustable gastric banding (Lap-Band®) and vertical sleeve gastrectomy.
Return to top
Who will perform my weight loss surgery?
Dr. George Kerlakian performs all the weight loss surgeries at Good Samaritan Hospital. He has been performing Roux-en-Y gastric bypass surgery since 2001, and began performing laparoscopic adjustable gastric banding (Lap-Band) in May 2006. Read more about Dr. Kerlakian.
Return to top
Who else will take part in my care delivery?
A multidisciplinary team of TriHealth-employed dietitians, exercise physiologists, mental health providers and nursing caregivers to help our patients achieve a complete lifestyle change. View a complete list.
Return to top
Why is it significant that the Good Samaritan Weight Management Center is recognized as a Bariatric Surgery Center of Excellence by the American Society for Bariatric Surgery?
As a Center of Excellence, the we are formally recognized for high-quality care in weight loss surgery. By definition, programs with ASBS Center of Excellence designations practice only top-quality care, ensuring efficacy of the procedure with each patient to the best of its abilities. This designation also is important because it means we can provide care to Medicare patients – only ASBS Centers of Excellence are approved for these surgeries.
Return to top
Paying for Surgery
Does insurance cover weight loss surgery?
We accept most insurance plans, and as a Bariatric Surgery Center of Excellence, we are a provider for Medicare patients seeking bariatric surgery. Out-of-pocket payment arrangements can be made for patients whose insurance companies list bariatric surgery as an exclusion.
Return to top
Why does it take so long to get insurance approval?
After your consultation is completed, it usually takes your doctor one to two days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from about three to four weeks or longer if you are not persistent in your follow-up. Most treatment centers have insurance analysts who will follow up regularly on approval requests. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.
Return to top
What can I do to help the process?
Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide “necessary” information. Letters from your personal physician and consultants attesting to the “medical necessity” of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.
When the letter is submitted, call your carrier regularly to ask about the status of your request. Your employer or human relations/personnel office may also be able to help you work through unreasonable delays.
Return to top
What if my insurance carrier denies approval?
Payment may be denied because there may be a specific exclusion in your policy for weight loss surgery or “treatment of obesity.” Insurance payment may also be denied for lack of “medical necessity.” Even if your initial request for pre-authorization is not approved, you still have options available. Insurers provide an appeal process that allows you to address each specific reason they have given for denying your request. It is important that you reply quickly. It is also recommended that, at this point, you enlist the help of an experienced insurance attorney or insurance advocate to properly navigate the complexities of the appeal process. Some insurers place limits on the number of appeals you may make, so it is important to be well prepared and that you clearly understand the appeal rules of your specific plan.
Return to top
Preparing for Surgery
If I want to undergo weight loss surgery, how long do I have to wait?
New evaluation appointments can usually be booked within a couple of weeks. Once a patient is seen, if the surgeon and patient agree it is appropriate and upon completion of all other appointments, the operation can usually be scheduled within eight weeks.
Return to top
What can I do before to speed up the process of getting ready for surgery?
There are several things you can do to speed up the process:
- Select a primary care physician if you don’t already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA).
- Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
- 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.
- Bring a list of your medications with dose and schedule.
- Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.
Return to top
What are the routine tests before surgery?
Certain basic tests are done prior to surgery, including:
- A Complete Blood Count (CBC)
- Urinalysis
- A Chemistry Panel, which gives a readout of about 20 blood chemistry values
Other tests may be done if necessary:
- 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. Women may have a vaginal ultrasound to look for abnormalities of the ovaries or uterus.
- Some surgeons may ask for a gallbladder ultrasound to look for gallstones.
- Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or additional psychiatric evaluation, may be requested when needed.
Return to top
What is the purpose of all these tests?
An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels.
What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
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 bariatric surgery if it is otherwise appropriate, but those conditions will make a patient’s risk higher than average.
Return to top
Will I be asked to stop smoking?
Patients are encouraged to stop smoking at least one month before surgery.
Return to top
Surgery
Will I have a lot of pain?
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. While you are still in the hospital, a Patient Controlled Analgesia (PCA), which allows you to give yourself a dose of pain medicine on demand, may be used by your physician. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about other pain management options.
Return to top
Will the doctor leave a drain in after surgery?
Some patients will have a small tube to allow drainage of any accumulated fluids from the abdomen. This is a safety measure, and it is usually removed one week after the surgery. Generally, it produces no more than minor discomfort.
Return to top
If I have surgery, what can I expect when I wake up in the recovery room?
Some doctors will provide a Patient Controlled Analgesia (PCA) or a self-administered pain management system, to help control pain. Others prefer to use an infusion pump that provides a local anesthetic in the surgical site to control pain without the side effects of narcotics. As with any major surgery, you are in danger of death from a blood clot or other surgical side effects. Statistically, the risk of death during these procedures is less than one percent. Your doctors will have assessed you for risks and prepared accordingly.
All abdominal operations carry the risks of bleeding, infection in the incision, thrombophlebitis of legs (blood clots), lung problems (pneumonia, pulmonary embolisms), strokes or heart attacks, anesthetic complications, and blockage or obstruction of the intestine. These risks are greater in morbidly obese patients.
Return to top
How soon will I be able to walk?
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.
Return to top
How long do I have to stay in the hospital?
Your stay in the hospital will be as long as it takes you to be self-sufficient. Although it can vary, the hospital stay (including the day of surgery) can be one to two days for a laparoscopic band, two to three days for a laparoscopic gastric bypass, and five to seven days for an open gastric bypass.
Return to top
How soon can I drive?
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 seven to 14 days after surgery.
Return to top
Life after Surgery
What happens to the lower part of the stomach that is bypassed (gastric bypass)?
In some surgical procedures, the stomach is left in place with intact blood supply. In some cases it may shrink a bit and its lining (the mucosa) may atrophy, but for the most part it remains unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food - it makes intrinsic factor, necessary to absorb Vitamin B12 and contributes to hormone balance and motility of the intestines in ways that are not entirely known. In the BPD procedures, some portion of the stomach is completely removed.
Return to top
What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?
The staples used on the stomach and the intestines are very tiny in comparison to the staples you may have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.
Return to top
Will I be miserably hungry after weight loss surgery since I’m not eating much?
Most patients say no. In fact, for the first four to six 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.
Return to top
What if I’m not hungry after surgery?
It’s normal not to have an appetite for the first month or two after weight loss surgery. If you are able to consume liquids reasonably well, there is a level of confidence that your appetite will increase with time.
Return to top
How long will I be off of solid foods after surgery?
Most surgeons recommend a period of four weeks or more without solid foods after surgery. A liquid diet, followed by semi-solid foods or pureed foods, may be recommended for a period of time until adequate healing has occurred. Your surgeon will provide you with specific dietary guidelines for the best post-surgical outcome.
Return to top
Is there a problem with consuming milk products?
Milk contains lactose (milk sugar), which is not well digested. This sugar passes through undigested until bacteria in the lower bowel act on it, producing irritating byproducts as well as gas. Depending on individual tolerance, some persons find even the smallest amount of milk can cause cramps, gas and diarrhea.
Return to top
Can I eat red meat after surgery?
You can, but you will need to be very careful, and we recommend that you avoid it for the first several months. Red meats contain a high level of meat fibers (gristle) which hold the piece of meat together, preventing you from separating it into small parts when you chew. The gristle can plug the outlet of your stomach pouch and prevent anything from passing through, a condition that is very uncomfortable.
Return to top
Will I be allowed to drink alcohol?
You will find that even small amounts of alcohol will affect you quickly. It is suggested that you drink no alcohol for the first six months. Thereafter, with your physician's approval, you may have a glass of wine or a small cocktail.
Return to top
Is there any difficulty in taking medications?
Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid form or crushed.
Return to top
Will I have to change my medications?
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 medications that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Usually no change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (many 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.
Return to top
Will I need to take vitamins after gastric bypass surgery?
Most surgeons recommend a daily multivitamin, calcium, and vitamin B12 for the rest of your life. B12 injections are sometimes suggested once a month for the first year and every six months thereafter. B12 may also be taken orally or sublingually (under the tongue) by most patients. The dietician will provide specific guidelines on necessary vitamin supplementation, dependant upon your surgical procedure.
Return to top
Is sexual activity restricted?
Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about six weeks.
Return to top
Can I take birth control following gastric bypass surgery?
Sexually active women should use more than one method of contraception for at least 18 months post surgery. Due to malabsorption with gastric bypass, hormonal methods of contraception such as birth control pills or injections like depoProvera may be less effective. A barrier method such as condoms (male or female), diaphragms and spermacides should be used in conjunction with a hormonal contraceptive. Unplanned pregnancy during the first 18 months post surgery carries high risk. To determine the best methods of birth control for you, schedule a consultation with your OB/Gyn physician.
Return to top
Is there a difference in the outcome of surgery between men and women?
Both men and women generally respond well to this surgery. In general, men lose weight slightly faster than women do.
Return to top
Will I have excess skin after surgery?
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.
Return to top
Will I lose hair after surgery? How can I prevent it?
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. Most patients experience natural hair re-growth after the initial period of loss.
Return to top
|
