Preoperative Tests & Consults
Reason for Preoperative Tests / Consults 1. Personal medical history 2. Bariatric surgery program 3. Insurance companies set forth certain pre-operative test requirements
Reason for Preoperative Tests / Consults Personal medical history Based on your own medical history and medical conditions certain tests or consults will be asked of you to complete prior to your surgery These tests or consults will provide our bariatric team with a better insight the care we must provide to you
Reason for Preoperative Tests / Consults Bariatric surgery program Provide knowledge about the various surgical weight loss options Provide an understanding about the short term & long term risks associated to surgery Ensure an individual understands the lifestyle changes that must be made Understanding of how the surgery is a tool for weight loss and maintenance
Reason for Preoperative Tests / Consults Insurance companies Insurance companies set forth certain pre-operative test requirements To evaluate and ensure an individual meets the criteria for surgery To evaluate and ensure an individual is medically stable to undergo surgery To evaluate and ensure and individual is emotionally stable to undergo surgery
Blood-work Blood work can yield some very important information about your health and wellbeing Blood work provides a baseline about your health and to see if there is any improvement or decline over time Some vitamin levels are evaluated such as B12, Vitamin D to name just a few
Blood-work Common Blood Tests: Lipid profile provides information about your cholesterol levels such as LDL, HDL, triglycerides CBC provides information about your red blood cells, white blood cells, platelets, anemia CMP provides information about your kidneys, liver, electrolytes, blood sugar, and blood proteins TSH provides information about the function of your thyroid Hemoglobin A1c (HgbA1c) provides an estimate of your average glucose level; this blood level aids in the detection and or monitoring for diabetes
Upper Gastrointestinal X-ray (UGI X-ray) Upper Gastrointestinal X-ray also known as a barium swallow UGI x-ray looks at the upper and middle sections of the gastrointestinal tract UGI x-ray is a safe, noninvasive procedure You are fully awake during this procedure You will be standing upright or be asked to lay down for a short period of time The procedure does not cause pain and does not require an IV If you are or there is any chance you are pregnant please inform the staff prior to the procedure
Upper Gastrointestinal X-ray (UGI X-ray) The small amount of barium contrast you drink at the time of the X-ray shows the movement of the barium through your esophagus, stomach and the first part of you intestine The UGI X-ray can show conditions such as hiatal hernia, severe reflux, strictures (narrow spots), swallowing issues After bariatric surgery an UGI x-ray provides important information about the size of your esophagus and stomach along with any physical restriction to your esophagus, & stomach.
Upper Endoscopy (EGD) EGD also known as an Upper Endoscopy Please be sure to follow the physician s instructions about preparing for the test and what to do after the test. EGD is a minimally invasive procedure requiring sedation or anesthesia The procedure visualizes the internal anatomy of the upper gastrointestinal (GI) tract and the first part of the small intestine (duodenum) The physician will place a small tube with a camera on the end of it to visualize the first part of your GI tract
Upper Endoscopy (EGD) The EGD will provide important information about the inside of your GI tract for your bariatric surgeon who will be performing surgery on your stomach Prior to bariatric surgery key aspects need to be assessed such as acid reflux gastric ulcers / duodenal ulcers esophageal sphincter function overall musculature of the upper GI tract along with any other medical conditions of the GI tract A tissue specimen (biopsy) is commonly obtained during this procedure Occasionally a bacteria known as H-pylori is identified which needs to be treated with oral antibiotics as this bacteria has been known to lead to ulcers
Primary Care Physician Primary Care Physician (PCP) is the physician or primary care provider who oversees your total care Your total care just to mention a few items includes well visits, preventative screening, blood work monitoring, knowledge of your medical history and your family history, provide care for you when you are sick, collaborative care between your other specialty doctors Developing a long-term relationship with your PCP is important Your PCP is also an educational resource Specialists are consulted to help manage one specific area of your care not to take over your total care
Cardiologist Evaluation A Cardiologist is a physician who is certified to treat problems of the cardiovascular (heart) system Some insurances do require an assessment and clearance note from a cardiologist Our bariatric program may require an assessment and clearance note from a cardiologist based on your medical history We need to know that your heart is able and ready to undergo bariatric surgery
Cardiologist Evaluation Your cardiologist may have specific recommendations to be followed before or immediately after your surgery The cardiologist will be the person to decide what type of cardiac test is needed based on an individual assessment of you What type of tests might be ordered: EKG, Echocardiogram, Stress test, or other type of tests based on your cardiologist s evaluation A cardiac clearance note is completed by the Cardiologist once you have met with the cardiologist and completed any cardiac tests ordered
Pulmonologist Evaluation A Pulmonologist is a physician who is certified to treat problems of the pulmonary (breathing) system A Pulmonologist can help you diagnose and manage sleep apnea, asthma, emphysema
Pulmonologist Evaluation PFT also known as a pulmonary function test measures how well the lungs take in and release air and how your body moves oxygen Sleep Apnea is when a person stops breathing repeatedly during their sleep, sometimes hundreds of times during the night without being aware An individual with Sleep Apnea may sleep for 8 hrs but awake feeling as though they have only slept for 30 minutes The degree of sleep apnea is increased with obesity A Pulmonologist can provide you with further details about diagnosis and treatment for sleep apnea
Endocrinologist An Endocrinologist is a physician who specializes in and treats disorders of the endocrine system The Endocrine System Consists of hormone producing glands in the body Regulates virtually all body functions Some of the endocrine glands Pancreas Thyroid Ovaries Adrenal glands Pituitary glands
Endocrinologist An Endocrinologist may also be involved in the care of individuals with diabetes Nearly 90% of patients with newly diagnosed type II diabetes are overweight or obese. The American Association of Clinical Endocrinologists have acknowledged that the beneficial effect of surgery on reversal of existing diabetes mellitus and prevention of its development has been confirmed in a number of studies. References: http://www.cdc.gov/healthyweight/effects/ http://www.idf.org/webdata/idf-bariatric-executive-summary.pdf http://www.aace.com/files/dm-guidelines-ccp.pdf
Behavioral Evaluation Behavioral evaluation is an insurance requirement and the bariatric program s requirement A behavioral evaluation is conducted by a licensed behavior specialist such as a Psychologist, Psychiatrist, Social Worker, or a behavioral health specialist A behavioral evaluation is an evaluation of an individual persons readiness to undergo major lifestyle changes The behavioral evaluation is not a pass or fail interview
Behavioral Evaluation The evaluation process assesses an individual s understanding of bariatric surgery regarding the short term and long term risks and benefits, realistic expectations with weight loss surgery The evaluation looks at an individual s readiness, motivation, and commitment to lifestyle changes The evaluation also looks at one s own coping mechanisms, support systems, and resources An individual who has been diagnosed and is being treated for depression, eating disorders, or other behavioral conditions may still qualify for bariatric surgery
Supervised Dieting Half of the insurance companies require 3 months, 4 months or 6 months of consecutive dieting under the supervision of a licensed healthcare professional Those individuals that are not required by their insurance company are strongly encouraged to work with our program s Registered Dietitian until they are ready for surgery Each month the following items need to be addressed to meet the criteria for supervised dieting: food choices, caloric intake, exercise type/ duration / frequency, blood pressure checks, body weight, emotional / behavioral changes, and the consideration of weight loss medications
Supervised Dieting Weight loss prior to surgery is strongly encouraged to decrease the size of an individual s liver at the time of surgery Losing weight prior to surgery is not an attempt to see if you can lose weight; we know you have lost weight many times in your lifetime but the weight always comes back known as yo-yo dieting Learning and practicing specific eating techniques and food choices prior to surgery is very beneficial for the long term Individuals who embrace this pre-operative dieting period of time gain important knowledge and can more easily make the necessary lifestyle changes after surgery