The soonest appointment I could arrange is in 2 months. I’d like to get started with the preoperative workup as as soon as possible. Should I set up my consultations with the psychiatrist, the nutritionist, and the gastroenterologist so that everything is “all set” when I finally see the surgeon?
You are certainly free to arrange any of these visits before meeting with your surgeon. However, remember that only your surgeon can definitively determine whether you are a good candidate for weight loss surgery. There is a chance that the surgeon may feel you are not quite ready for weight loss surgery — if this is the case, then some or all of your preop consultations may need to be repeated at a later date. To avoid any chance of this happening, most people wait until their surgical consultation before scheduling any of the other ones.
Most insurance carriers will require you to show evidence of weight loss supervised by your primary care doctor for between 3 to 6 months. You will find it helpful to get this out of the way, providing it is done no earlier than one year prior to surgery.
I live outside the New York Metropolitan area. How much of the preop workup can be done locally?
You can arrange a significant portion of the above workup to be done in your local area. You can have your primary care doctor arrange for your endoscopy locally. The blood, urine, and other tests may also be performed locally. Obviously, the preop meeting with the surgeon needs to be done in our New York office, so you need to make at least one or two trips here before your surgery! You will also need to meet in person with one of the nutritionists here at the Mount Sinai Health System Weight Loss Surgery Program.
I’ve heard that every bariatric patient needs to have an endocrine evaluation to make sure that there is no hormonal reason for their obesity. Does this mean that I need to see an endocrinologist before surgery?
All patients will have a thyroid hormone level checked prior to surgery, since hypothyroidism (low thyroid level) can cause obesity. However, this is a simple blood test that does not require a formal consultation with an endocrinologist. If you have a more serious endocrine problem, such as severe diabetes or Cushing’s disease, you will be asked to consult with an endocrine specialist before being considered for surgery.
What happens if the insurance company decides not to authorize my surgery?
If your insurance denies the preauthorization, you have several options available. The first step would be to appeal the denial. If this is unsuccessful, you may request an outside reviewer to examine your request. Finally, there are some legal firms that specialize in helping overweight individuals get approval for surgery. As a last resort, some patients have switched their insurance to a different company. Luckily, these more drastic measure are rarely needed.
What is a nasogastric, or NG tube? Will I have one of these tubes in my nose after surgery? Will I have any tubes or drains in my belly?
A nasogastric, or “NG” tube, is a small flexible plastic tube that passes through the nose into the stomach. Its purpose is to drain out air and secretions from the stomach pouch.
Our surgeons do not typically use nasogastric tubes after surgery. However, there is a small chance that you may have one of these tubes for a short duration, if your surgeon feels that it is necessary.
You will have a urinary catheter inserted into your bladder while you are asleep. This will usually be removed right after your operation, or on the first day after surgery. The tube is not painful, and most patients barely notice that it’s there. Removing the tube is a quick and painless.
Can I be 100% guaranteed that I’ll be ready for discharge by postop day #2 or #3?
Absolutely not! Remember that the hospital course described above is for patients who have a completely “normal” recovery. If you have major medical problems that require treatment during this time, or if you have complications of surgery, your hospital stay may be substantially longer!
What medications will I be taking once I am discharged from the hospital?
If you were taking any medication prior to surgery, you will probably resume these unless they may irritate your stomach (like aspirin or ibuprofen). In addition to a prescription pain medication, you may be advised to take one or more of the following, depending on which operation you had:
- A chewable multivitamin tablet, such as Flintstone’s or Centrum chewables, twice a day.
- A chewable calcium tablet, like TUMS or Viactiv, twice a day.
- A protein shake is optional, but may be very useful to help you achieve your protein requirement during this period of early healing.
Is it OK if I become pregnant after weight loss surgery?
If you are female, it is critically important that you avoid becoming pregnant during the first year after weight loss surgery. Because your body is in “starvation mode” during this time, your fetus may not develop normally. It is imperative to use an effective means of birth control during this period or to abstain from sexual intercourse. If you do become pregnant during this time you should contact your surgeon immediately!
Does weight loss surgery affect fertility?
Yes, it does. For many years, fat was thought to be nothing more than energy storage. It is now recognized that fat is actually a very hormonally active tissue, producing both female hormones (like estrogen) and male hormones (like testosterone). This is why some obese women have male hair patterns (like facial hair) and why some obese men have female attributes (like breast tissue).
As you lose weight, the hormonal effect of excess fat decreases. This may result in a substantial increase in your fertility. Although we would never describe bariatric surgery as a treatment for infertility, many women who were previously unable to become pregnant find that they become fertile after substantial weight loss.
This is one more reason why it is so important to use an effective form of birth control for the first 18 months after surgery!