A Success Guide to WEIGHT-LOSS SURGERY

Transcription

1 A Success Guide to WEIGHT-LOSS SURGERY

2 Congratulations on taking the first step toward losing weight! Numerous patients have experienced great success in losing inches and pounds through laparoscopic gastric band, gastric sleeve and Roux-en-Y gastric bypass procedures. Many patients would call their procedure a life-changing experience, as they now have renewed confidence, health and energy. Joan and Ann Kirchner Bariatric patients We understand that choosing to have weight-loss surgery is an important decision, and I hope this booklet proves to be a valuable resource for you. Sincerely, Checklist for weight-loss surgery Addressing the comorbid conditions of obesity with weight loss Kim McCoy, RN, CDE Bariatric Program Manager Avera Bariatric Institute kim.mccoy@avera.org Patient is a key partner in successful bariatric surgery Three bariatric procedures fulfill differing weight-loss needs Mother and daughter take on new lives Supervised Medical Weight Loss 1

3 The Avera Bariatric Institute The Avera Bariatric Institute offers three weight loss procedures that are covered by most insurance companies: Laparoscopic adjustable band Roux-en-Y gastric bypass Sleeve gastrectomy We want to make this process simple to follow. Please review the checklist below as these are the steps to move forward in your journey to weight loss and improved health! Typically, insurance will consider coverage for weight loss surgery for patients who have: A body mass index (BMI) of 35 to 40 along with one or more comorbidities, such as sleep apnea, type 2 diabetes, acid reflux or high blood pressure A BMI of 40 or over for any surgery with no additional comorbidities Checklist for Weight Loss Surgery Attend a seminar. A seminar will provide you with more details about weight loss surgery and the required lifestyle changes after surgery. If you are unable to attend due to your schedule, there is an on-line seminar option. Make sure you complete the quiz after you vie the seminar if you want to move forward with the process. Verify insurance benefits. Make sure that you have insurance benefits for bariatric surgery. Contact the insurance provider s customer service department and verify benefits for bariatric surgery. Most insurance companies have this information online which may be a easier way to find the information. Some insurance companies require six months of supervised weight loss by a primary care provider. During this time period, you can attend the seminar to prepare for weight loss surgery options. A Supervised Medical Weight Loss (SMWL) form has been created to assist your primary care provider in the type of information needed for documentation. This form is available at the end of the brochure. Complete supervised medical weight loss. There are some insurance plans that require you to visit monthly with your primary care physician on a diet and exercise plan prior to authorizing bariatric surgery. At the end of this brochure I have included the type of information most insurance companies require to be documented for those visits. Consult with a bariatric surgeon. Once you have attended a seminar and know that you have benefits for bariatric surgery at the Avera Bariatric Insitutue, you can contact the Surgical Institute and get scheduled with a Bariatric Surgeon. Psychological consult. Surgery is often the easy part, but it is the lifestyle changes that can be very difficult. The Psychologist assessment will provide you and your surgeon with a valuable objective determination regarding your potential for success with long-term weight loss. Nutrition consult. You will meet with a Registered Dietitian and be educated about the lifestyle changes that you will need to incorporate. You may be asked to complete a food diary as the dietitian will want to review your current meal and exercise regimen and make suggestions for improved health. We will manage your medications through your primary care provider. As weight changes, hypertension and diabetes medication dosage will need adjustments. We ask that patients see their primary care physician within one month after surgery. We also ask patients who are on an insulin regimen before surgery to have a plan with their primary care physician for insulin usage after surgery. Optimize your health before surgery. This can vary greatly for each patient. Our goal is to make sure you decrease your risks as much as possible before surgery. This optimization may include: getting tested for sleep apnea, stabilizing your blood sugars, losing a small percentage of weight prior to surgery, normalizing blood pressure and taking vitamin and mineral supplements. There is no other surgery that requires more preparation and team effort. Studies support these efforts for optimal weight loss and long-term maintenance and your optimal health is our ultimate goal for you! 2

4 Addressing the Comorbid Conditions of Obesity with Weight Loss Obesity has been called an epidemic in our society, and is the center of many health problems that Americans experience. Comorbidities of obesity are many, including type 2 diabetes, sleep apnea, gastric reflux, hypertension, high cholesterol (metabolic syndrome), cardiac disease, joint dysfunction, back pain, depression and more. It s estimated that approximately one in three deaths from cancer each year is related to obesity, poor nutrition or physical inactivity. Weight loss can contribute to a decreased mortality from risks such as type 2 diabetes, hypertension and coronary disease, and the specialists of the Avera Digestive Disease Institute recommend plans which decrease caloric intake, maintain a balanced diet and include physical activity. When weight loss succeeds, the impact is significant upon comorbid conditions. It s not unusual to see the need for medications literally melt away with the pounds for the treatment of conditions like GERD, type 2 diabetes, pain and hypertension. -Steven Condron, MD, MHES, FACP Board-Certified Gastroenterologist with Avera Medical Group Gastroenterology Dan and Holly s Story Dan and Holly Elbert lived a relatively sedentary lifestyle prior to having their bariatric surgeries at the Avera Bariatric Institute. Due to their weight, the couple was often limited in the types of activities they were able to participate in, and typically stuck close to home. We didn t do a lot of things that we probably would have liked to do because of our weight, says Holly. Before the procedure, I had tried several diets. I would lose some and gain it back. Dan and Holly Elbert Bariatric patients Dan was an athlete in high school, but his activity level trickled down to virtually nothing upon graduation. In the last few years before my surgery, I didn t get off the couch, he said. The couple finally reached a breaking point, and grew tired of feeling bad about their size and lack of energy. For me, I just got tired of being big, and nothing was working to lose the weight, says Dan. So, I decided to have a lap band surgery. I never looked back. I was 318 pounds. Not long after Dan s surgery, Holly, who weighed 258 pounds, witnessed his remarkable transformation, and was eager to have the lap band procedure herself. Learn more about Dan and Holly at Avera.org/weightlosssurgery 3

5 PATIENT is a Key Partner in Successful Bariatric Surgery When bariatric surgery is considered for weight loss, the patient is such a vital partner in the process that extensive education and assessment are required before the patient is considered as a surgical candidate. Avera McKennan Hospital & University Health Center is accredited by the Metabolic Surgery Accreditation and Quality Improvement Program (MBSAQIP) Accredited Center. The MBSAQIP accredits facilities in the United States that have undergone an independent, voluntary and rigorous peer evaluation in accordance with nationally recognized bariatric surgical standards. Bariatric surgery accreditation not only promotes uniform standard benchmarks, but also supports continuous quality improvement. Bariatric surgical procedures have been shown to reduce obesity, improve mortality and decrease the health risks from chronic diseases such as cardiomyopathy and diabetes. For these reasons, the MBSAQIP Accreditation Program recognizes those facilities through accreditation that implement defined MBSAQIP standards of care, document their outcomes and participate in regular reviews to evaluate their bariatric surgical programs. For morbidly obese patients, the 15-year success rate for losing weight and keeping the weight off through bariatric surgery is 50 to 60 percent, said Bradley C. Thaemert, MD, FACS, Surgeon with Surgical Institute of South Dakota. Yet without surgical intervention, the long-term success rate is only 5 percent. Surgery helps with success because it suppresses appetite. Beyond that, success depends upon the patient, because it s possible to eat around any weight-loss surgery. If patients qualify, they visit with either Michael Bauer, MD, FACS, David A. Strand, MD, FACS, or Brad Thaemert, MD, FACS, with the Surgical Institute, who go in depth about the different procedures. After surgery, patients have extensive follow-up to help them eat successfully. An underlying shift in thinking is one of eating to live, rather than living to eat. Patients learn to look at food as a source of nutrition and energy, rather than a cure for boredom or stress. After 12 months, all bariatric surgery patients are up to eating very similarly: 8 ounces of food at each meal. Success with weight loss is one-third the surgery to control hunger, one-third the choice of foods and eating habits, and one-third exercise. In order to lose 100 pounds and maintain the weight loss, 50 minutes of activity, five days a week is the recommendation. That can include walking, swimming, a fitness class or biking. All patients return for an office visit seven to 10 days post surgery, then one month later. After the initial visits, lap band patients come once every month for the next 12 months, and sleeve gastrectomy and gastric bypass patients have two additional follow-up visits the first year after surgery. Patients are also encouraged to take part in a support group, and are followed for a lifetime. u exercise control hunger eating habits 4 There is no magic bullet for weight loss including bariatric surgery. If patients do not follow the post-surgical recommendations, they will not lose weight, or they will gain it back. Yet the majority of patients who do take the step of bariatric surgery experience successful outcomes. - Kim McCoy, RN, CDE Bariatric Program Manager

6 Both the sleeve gastrectomy and gastric bypass procedures are performed minimally invasively, however, patients stay in the hospital two days, and typically take a couple weeks off work. Weight loss is generally faster and greater with these two procedures, although some patients do just as well with lap band. Lap band has less than a 0.5 percent risk for mortality due to complications, and bypass and sleeve gastrectomy procedures have a 1 percent risk of mortality. This risk is low compared to the risk presented by morbid obesity. Complications after surgery, while rare, may include bleeding, infection, a blockage or tear in the bowels, or need for further surgery. Pregnancy is not recommended for 24 months after a gastric sleeve or bypass surgery; however, pregnancy is fine after lap band surgery. Patients who lose weight and maintain weight-loss experience greater quality of life emotionally and socially, and the health benefits are many. Research indicates the following health benefits accompanying weight loss: Improved survival of obesity-related disease, especially type 2 diabetes Decreased blood pressure Among diabetics, lower blood sugar levels and less need for medication or insulin Prevention of new cases of type 2 diabetes Improvement of obstructive sleep apnea Improvement in mobility Improvement in mood and self-confidence Lowered risk of heart disease Lowered risk of many cancers, including breast, colon, kidney, pancreas and esophageal u It s the most rewarding surgery I do because it cures more conditions than any other surgical procedure. This may include diabetes, back pain and hypertension. Plus, patients may get their social life back and re-engage in the community. Dr. Thaemert has performed more than 500 bariatric surgeries. Bradley C. Thaemert, MD, FACS General and Bariatric Surgeon It s become a necessity to learn how to take care of patients who are overweight and help them with their comorbid conditions since we know diet and exercise alone doesn t work for everyone long term. David A. Strand, MD, FACS General and Bariatric Surgeon Dr. Strand has performed more than 350 bariatric surgeries. LAP BAND SURGERY SLEEVE GASTRECTOMY SURGERY 5 GASTRIC BYPASS SURGERY

7 Mother and Daughter Take On New Lives Joan Kirchner and her daughter, Ann Kirchner, lived a lifestyle filled with unhealthy choices. But in March 2012, they decided to make a change. Together, they ve embarked on a journey of surgical weight loss, lost over 200 pounds between the two of them and haven t looked back. When Joan, 67, and Ann, 43, decided they had enough of dealing with joint and other health problems because of their weight, they made a commitment to a new lifestyle. I weighed 266 pounds. I didn t exercise, I ate a lot of fast food, I ate more than I should have, and I drank lots of soda, says Joan. I just didn t care. Ann says she did the same things as her mother. I tried to eat right but I just couldn t get anything to stick, she says. Ann, who at her highest weight was 332 pounds, described herself at the time as a workaholic, working 75 to 80 hours a week. She says she just got sucked into bad habits. Joan reflects on her medical issues. I was a diabetic and on so many medications. Now I m off of all my medications, no longer a diabetic, and I m just enjoying life now. I finally feel like I ve found the real me. I love life! 6 Before surgery, Ann also battled her demons of eating right and exercising. I had high blood pressure, high cholesterol. I also battled depression. Ann says before her surgery, exercise was nonexistent for the most part. It was off and on, I would do a couple of things, and I would give up because it was too hard, or

8 at least I thought it was too hard. Ann s cupboards weren t filled with nutritious staples, either. Fast food was definitely a staple in my house. A lifestyle change Both women say they made the best choice for themselves and would do it all over again. Not that they plan on it. I don t have to give up the things I love, says Joan. I make a choice as to what I want to eat and what I don t want to eat, and if I want to have that piece of candy or that piece of cake, that s my choice. I can still have it, but in moderation, and I ve learned to modify what I want. Ann agrees. We still feel like we re you know, we re splurging, but it s within our range for the day of what we re supposed to have. Embracing the little things Since Ann had her surgery in March 2012, she s had quite a few aha moments. I used to not be able to cross my legs, and I can do that now. Sit here and actually tie my shoe without putting it up on something. Joan says her biggest thrill is that she doesn t have to take her insulin anymore. I am no longer considered diabetic. I got rid of the bracelet that says I m a diabetic, and all the insulin is gone. All the pills are gone, and I m down to my very last pill that I m taking, and I was on 10 or 12 prescriptions plus 150 units of insulin every day. Joan also says she s really enjoying getting back to doing the things she loved when she was younger. I wasn t able to run now I m hitting that track again. I bet it s been 30 years! A daily battle Despite all the success, Ann admits she still battles on a daily basis. One of the hardest things for me is when we do go out because I can t measure my food. Joan agrees and says limiting herself is her biggest hardship. I think, can I stop at one piece without sitting there and eating the whole bag? Not a fix-all Both Joan and Ann want to stress that surgery is not a fix-all. You have to want to change your lifestyle. The mother-daughter duo also stress they re not on a diet. It s a whole different outlook on life. If you don t make those changes in your life, then you re going to go right back, Joan says. The two say their entire lives have changed since they took the leap and had their surgeries. Ann says their personal relationship has changed as well. I think we ve gotten closer because going through this experience together, we talk a lot about what s working, what s not working. Ann jokes that the easy part was having the surgery. It s what comes after the surgery that s when the real work begins. u Learn more about Ann and Joan at Avera.org/weightlosssurgery This is something we know we ll have to work at every day for the rest of our lives. 7

9 (Example) Supervised Medical Weight Loss Progress Note Patient s Name: Practitioner Seen: Date of Birth: Appointment Date: Vital Signs: Patient s Surgeon: (Please select one) Height O Dr. David Strand Weight O Dr. Bradley Thaemert Blood Pressure O Dr. Michael Bauer Pulse Respirations Temperature This year old male/female presents to the clinic for his/her supervised medical weight loss program follow-up. This is visit number of. He/she is morbidly obese (278.01) and has the following comorbidities: The patient has made numerous unsuccessful weight loss attempts in the past. Currently he/she is on a restricted calorie diet and exercise program consisting of: I have discussed the effects that the disease of obesity has on his/her health and reviewed healthy eating choices, portion control, and reinforced the importance of a routine exercise regimen. I have recommended the following additional behavior modifications and/or lifestyle changes: He/she is also taking (medication) to assist with weight loss. He/she has lost/gained pounds since our last visit. His/her total weight change since initiating this medically supervised weight loss program is pounds. I will see him/her in one month to re-evaluate the current weight loss program. Physician s/nurse Practitioner s Signature *This is a template to capture the criteria required by the patient s insurance company for approval of bariatric surgery. If you are in need of further information or clarification, please contact Kim McCoy, RN at ~This form may be FAXED directly to the surgeon s office at (Example) 15-BARI