The Basics

Okay, one week from now I should be awake from the procedure and enjoying the nice morphine drip.  I thought that it might be nice to include the pre-surgery basics here for anyone who might be interested.  These are the steps you go through to prepare for surgery, and I highly recommend finding a doctor that includes at least this much homework prior to working on you…… 

Orientation and Insurance  

I’m guessing that most surgeons will have some sort of meet n’ greet like I attended……mostly for some basic education about the surgery options, and to give you some idea about how your insurance is going to react to you trying to get them to pay for bariatric surgery.  I started this whole process in November of ’06, thinking at first I was going to do lapband.  Due to the fact that my insurance will not pay for surgery if you are over a certain BMI, and after doing some research on the lack of success that males 100+ pounds overweight experience w/lapband, I switched to the “permanent” gastric bypass procedure.  I took an extra couple of months to make sure I was comfortable with my decision, so naturally it took longer for me to go through the insurance approval process.  Count on at least six months from the time you decide to have surgery to the surgery itself.  It’s not a fast process, and it shouldn’t be. 

Psychological Evaluation 

Do not underestimate the necessity of visits with the psychologist.  I was shocked to see how many people during my orientation balked at this……”well I’ll just go to Monterrey Mexico and have it done”….etc.  I don’t understand how anyone could approach such a life altering surgery without considering the emotional and psychological ramifications.  Surgery is just a tool to facilitate your weight loss…….I’m guessing that longterm success will be about 90% mental.  Anyway, I’m happy that I was able to talk through a lot of my own demons with a professional up to this point.   

Dietician 

This part of the process is just learning exactly what you can and can’t eat after surgery, the importance of a lifelong vitamin regimen, etc. It’s the roadmap, if you will, that you will follow after surgery.  The first week will be clear liquids, second week will begin with eating one egg, and so on.  I don’t want to say that the education is kind of a scare tactic, because that is a bit strong, but it is definitely a reality check for what the rest of your life will be like.  Seeing the visual that your stomach will be about the size of an egg, and realizing you’ll never be able to guzzle water after mowing the lawn, puts things into perspective. 

1st Preop Consultation 

This is the first time you sit down with the surgeon for any length of time and talk about the process.  More importantly, this is where you actually get your surgery date.  Write down as many questions or concerns as you can possibly think of to bring to this appointment.   

Preop Lab Work 

Just a standard blood test.

 Pulmonary Clearance 

This is basically a couple of chest x-rays and breathing into a spirometer.  It is important that your lungs are in good shape right after surgery to avoid things like pneumonia. 

Cardiac Clearance 

EKG, stress test, etc.  This is a much longer appointment….up to three hours.  One piece of advice I’d give anyone going through this process is to ask any of the supporting staff exactly what is going to happen during the visit, and approximately how long you should expect to be there.   If you don’t know you’re going for a stress test and show up in nice clothes, or you don’t realize you’ll be gone for the rest of the afternoon…..that could cause some undue stress.  I think many doctors/nurses assume you know what’s coming….so be sure and ask.   

Preop EGD 

Since your stomach won’t be seeing food again, the doctor needs to go down there and take a look at it.  I don’t remember anything about this procedure because I was out cold, but it’s your run of the mill tube camera down the throat. 

Blockage Checks 

From my research, I think this step in the process was unique to me.  At least I hope it was.  I keep forgetting to call my surgeon to make sure this was supposed to happen.  When I was leaving the hospital after one of my visits, a guy in a lab coat approached me in the parking lot “because they forgot something”.  He explained that it was important to check for any colon blockages or irregularities, and proceeded to walk me over to a van.  This is where it gets weird.  He had me drink a Dixie cup full of something he said would help “trace” my digestion, and after that I don’t remember anything.  I woke up in a wheelchair in the corner of the parking lot about thirty minutes later, with my pants around my ankles and my ass killing me….I mean just KILLING ME.  I haven’t gotten any bills for the procedure yet, and he didn’t even take my insurance information, so I’m not sure where to start with this one.  I’m serious, I was eating ice cream and sitting on a donut for about ten days after this.    

Preop Education Class 

This was really a big help for me.  This is where you go through the very specific details of what will happen to you before, during and after surgery.  Seeing it all broken down into a timeline was a very big stress-reliever for me.  The two days prior to surgery you’re eating a lot less (no food after noon the day before) and consuming magnesium citrate to get the system flushed out, etc..  I was concerned about whether or not I’d be able to take my regular medication after surgery…but apparently unless you’re taking horse pills you’re okay. 

Preop Physical Therapy Class 

Pretty good info about the importance of just moving around after surgery….to cut down on the chances of blood clots, pneumonia, etc.  Also emphasizes the importance of physical activity for the rest of your life.  You’ll be interacting with the physical therapist a lot right after surgery, so they go through all of the post-surgery details with you…..how to sit up in bed and how soon you’ll be up walking. 

Preop Anesthesia Review This is where you sit with an anesthesiologist and review information with them that, up to this point, you have shared with about five hundred different people at various doctor’s offices.  Funny thing is, that sort of thing is what has inspired this blog….if you’ve ever lost a lot of weight you know how flattering it is to explain your sudden weight loss for the first hundred times, and after that it would just be nice to have a place to say….”Thank you for noticing. I’m tired of talking about it, read the goddamn website”.    

2nd Preop Consultation 

This is where I’m heading this afternoon…..this is the last visit with the surgeon prior to surgery.  Last questions, preparation, short term disability discussions…..unless something weird has shown up in the cardiac, pulmonary or blood work, shouldn’t be a problem.    

So here you have a very small snapshot of what I’ve accomplished up to this point.  Other than the apparent anal rape in the hospital parking lot, I have to say that this has been a very smooth process.  I’m pretty nervous and excited about the big day, and hope to include some good information here later. 

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