Bariatric Center Georgetown Community Hospital
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Frequently Asked Questions
General Questions
Insurance FAQ’s
Nutrition Questions
Bariatric Behavioral Health Services
Pre-Surgery Scheduling Questions
Ask the Nurses
Ask Dr. Sonnanstine
General Questions
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As of January 1, 2010, the Bariatric Preparation Program Fee has been waived. This may be for a limited time, so start our program soon to secure this lower rate!
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First and foremost, educate yourself. Read all materials available from the Georgetown Bariatric Center, or downloadable from our website. Check out other reputable online resources like www.obesityhelp.com, www.ASBS.org, and www.obesityaction.org/weightlossoptions/bariatricsurgery. Attend our informational seminar, and/or one of our support group sessions. Listen to the stories of other weight loss surgery patients, which you can also find online or in print, but be aware of the individual differences in surgical experience and compliance. Begin to put in place the recommended healthy lifestyle behaviors that go hand-in-hand with weight loss success, such as weaning carbonated/caffeinated beverages, building in healthy protein sources to each meal, increasing physical activity as able, and cutting out simple and starchy carbohydrates. You will find that the sooner you “surrender” to these recommendations, the easier it will be to adopt and maintain this healthy lifestyle after surgery, and you will be more successful long-term in keeping off excess weight.
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There is no right or wrong surgery, but the choice is usually largely up to the patient, with input by the providers. The decision should be based first on a clear understanding of the basics of each surgery, including risks and benefits; health conditions which may favor the benefits of one surgery vs. another, or conversely, increase the risks; an acknowledgement of current eating style as to which procedure is truly “best fit”; and personal preference. Our goal is to help you make the best informed decision possible for your circumstances and health challenges.
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Your safety and comfort are of the upmost importance to us are Georgetown Community Hospital. To that end, we have purchased a great deal of furniture that is weighted to hold greater than 300 pounds. If you question the stability of any of our furniture, look for an aqua-colored band of tape on one of the front legs. If it meets our safety scale of 300 or more pounds, it will have that tape on the leg.
Our center (suite 230) is equipped with funiture that is weighted to a minumum of 600 pounds, with some pieces going up to 1000 pounds.
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We at the Bariatric Center at Georgetown Community Hospital are pleased to inform you of a recent development potentially impacting your obese patients who may be interested in weight loss surgery. Our Administrative Team, in recognition of these tough economic times and the financial challenges we all face, has approved, on a temporary basis beginning January 2010, the withdrawal of our $400 Bariatric Preparation Program Fee. While this decision was not reached easily, and involved much consideration of the financial implications to our hospital, we feel the withdrawal of this fee is one way we can make weight loss surgery more attainable to those who would benefit.
All patients can expect the same excellent, experienced care from our nationally known program, but there will be no out-of-pocket fee for the required Bariatric Preparation Program components (listed below).
Other out-of-pocket insurance co-pays, deductibles, self-pay pricing if applicable, and insurance criteria for weight loss surgery apply as always; as per the pricing guides and surgery criteria given to patients. Please also be aware that we do accept KY Medicaid as well as Medicare.
Our Preparation Program includes:
• Pre-operative Individual Psychological Evaluation
• Pre-Operative Psychological Readiness for Surgery Class(es) – group format
• Up to 3 Post-Operative Individual Psychological follow up Sessions
• Pre-operative Individual Dietary Consultation
• Pre-operative Nutritional Educational Class – group format
• 3 Post-Operative Individual Dietitian visits
• Support Groups – Weekly, Monthly and On Line
• If needed, 12 sessions of post-operative group therapy in our CBT/DBT skills group called Healthy New You.
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Please send an e-mail to info@georgetownbariatrics.com.
Insurance FAQ’s
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a. For commercial insurance policies; Contact the customer service number on the back of your insurance card and ask this question exactly. “In my certificate of coverage are there benefits for weight loss surgery for morbid obesity if medically necessary?”
b. For Medicare and Medicaid; there are benefits for weight loss surgery as long as the criteria is met. There is no need to contact Medicare and Medicaid.
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Most insurance companies that require a diet still require the diet no matter how many co-morbid diagnoses you have.
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YES…the diet is part of criteria set by your insurance company. Your physician can write you a letter of support which will assist in obtaining approval, but you still have to complete the diet.
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This is a question that is asked a lot…sometimes additional testing is required, one primary care may get the documentation back faster, or if your friend has a different insurance than you, maybe you were required to do a diet and your friend was not. If the insurances are different, then it may be because one insurance just takes longer to process than the other.
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Usually the diet must be for at least 6 full months, which is one initial visit and 6 follow-up visits. Your appointments must be consecutive and the diet must be successful, meaning your end weight must be the same or less than your start weight.
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This means that your particular plan does not have benefits for weight loss surgery, no matter if you meet the medical necessity requirements or not. Your insurance may tell you that you have appeal rights, keep in mind that you will be appealing policy and not medical necessity. If there are no benefits for weight loss surgery it basically means that the benefit was not purchased by your company.
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Please send an e-mail to InsuranceTeam@georgetownbariatrics.com.
Nutrition Questions
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Important not to take calcium and iron together. You should allow at least 2 hours between vitamins to maximize iron absorption.
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Not necessarily. Most people find that as their diet progresses and they move farther and farther out from surgery they are able to obtain the necessary amounts of protein that they need by means of the food that they are eating. However, if you are unable to consume enough protein rich foods to maintain an adequate amount of protein then you may have to resort back to protein powders and/or shakes.
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Unfortunately the answer is no, protein does not come in the form of a pill to be swallowed. You have to get your protein in the form of powders, shakes and/or drinks. The hardest time to get protein in is typically in the first two weeks of your diet immediately following surgery. It is at this time that you are limited to a liquid only diet so you must rely on the powders and shakes. As your diet advances after the first two weeks it becomes easier to seek alternative protein sources; mainly foods.
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There are numerous sources of protein through food and supplements. One ounce of meat contains 7 grams protein and 1 egg contains 6 grams protein. There are high protein cereals and oatmeals available. Protein bars and supplements can also be used to increase protein intake.
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Continue to try more flavors and varieties. There are even unflavored protein powders that can be added to foods and drinks. Once company makes a chicken soup flavored powder that can be added to soups. Be creative, making smoothies and shakes.
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Yes. The use of low-fat soy milk is completely acceptable if you find that you have become less tolerant of dairy products after surgery. This is a common occurrence for a lot of people.
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Send an e-mail directly to the dietitian! TheDietitian@georgetownbariatrics.com
Bariatric Behavioral Health Services
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First, please rest assured that it is perfectly normal to feel anxious about this component of your weight loss surgery journey. Some of our patients have never had any prior contact with mental health care providers or services and are uncertain what to expect. Others may have a history of depression, anxiety or psychiatric treatment that they fear may cause them to be “denied” clearance for surgery. We want you to know that regardless of your prior mental health care experiences, we expect your psychological evaluation to be a positive and helpful experience! There is no special preparation needed in advance.
At the Bariatric Center at Georgetown Community Hospital, pre-surgical psychological evaluation is called: Psychosocial Assessment & Consultation for Bariatric Surgery. Your assessment & consultation will be conducted on your first clinical appointment day, and it consists of both written tests and a face-to-face consultation. You complete your written test material in our education room, and your face-to-face consultation will be held privately with me in my office down the hall.
Please remember that here are no “right or wrong” answers to the written test questions. Just answer honestly and to the best of your ability. These questions are designed to help us get a clear “snapshot” of your strengths; any special needs you might have; your diet, exercise and lifestyle history; your mental health and well being; your support network and overall functioning in all spheres of your life.
We will discuss your answers together in the consultation, and we will use this information and our time together to create a customized plan to help you with your goal of advancing to surgery. Many patients who were initially nervous about the evaluation find that they actually enjoyed the process and now look forward to seeing me for their post-surgical follow up!
If you have any additional questions about your pre-surgical psychological evaluation, please don’t hesitate to ask. I look forward to meeting with you!
Lisa West-Smith, PhD, LCSW Director, Bariatric Behavioral Health Services
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The media frequently reports cases of alcohol misuse, drug abuse, gambling, shopping, promiscuity, etc. after weight loss surgery. These reports have lead to a strong public perception that weight loss surgery patients are suffering from “addiction transfer.” That is, bariatric surgery patients trade their “addiction” to food for an addiction to alcohol or drugs-----or that bariatric surgery patients trade their “addiction” to food for an “addiction” to unhealthy compulsive behaviors. In reality, there is very little scientific evidence to support this specific concept. One problem with the concept of “addiction transfer” is the technicality of how specific substances (such as food, mood altering drugs or alcohol) and addictive behaviors (such as gambling or compulsive shopping) are defined scientifically. Another problem is that we have very little data on the actual numbers of post-surgical patients who are affected by substance abuse or unhealthy behaviors after surgery.
However, it is clear that alcohol is absorbed rapidly in the new stomach pouch and small intestine of the gastric bypass surgery patient. Caution must be used as even a small amount of alcohol can result in intoxication. Some individuals report this is a quick sensation of a strong “buzz,” and of course intoxication can potentially lead to poor judgment, unhealthy habits and risk taking behavior. Although more research is needed to understand this, it also appears that patients with a history of alcohol abuse may be at a slightly higher risk of developing post-surgical alcohol misuse. Most importantly, it is clear that patients who use food to “self soothe” in response to emotional or other triggers will need to learn healthy coping mechanisms to avoid accidently developing these behaviors post-surgically. Significant attention paid to these topics in the Bariatric Surgery Preparation Program all GCH bariatric surgery patients receive. We welcome your questions and discussion on this important topic!
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Please send an e-mail to Dr.West-Smith@georgetownbariatrics.com.
Pre-Surgery Scheduling Questions
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PFT (Pulmonary Function Test) This breathing test is good for one year.
UGI (Upper G.I.) This test is good for one year.
Gallbladder Ultrasound (only needed if you are having gastric bypass and you still have a gallbladder) This test is good for one year.
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YES
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NO
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Yes you may bring someone over the age of 18. Spouse, caregiver, loved one or significant other.
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No-these test are only good for 45 days, so unless you have specifically been told to have one or more of these test done for a specific reason please do not get them done ahead of time.
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Cardiac clearance is a letter stating that you have been cleared from a cardiac standpoint for bariatric surgery. All tests supporting this need to be submitted to us as well (Echocardiogram, Stress test, EKG’S, Heart Cath’s, etc.) It is up to the Cardiologist to determine the best testing method to clear you for surgery.
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502.570.3719
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This needs to be discussed with Dr. Sonnanstine during your consultation appointment and depends on your type of surgery and your recovery rate. Everyone recovers at a different pace.
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Please bring those to your consultation appointment with Dr. Sonnanstine and give them to his staff or fax them ahead of time to 502.867.3304.
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Send an e-mail to Pre-OpScheduling@georgetownbariatrics.com.
Ask the Nurses
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It is very normal to hit plateaus in your weight loss journey. There will be times when you stop seeing the number on the scale change but that doesn’t mean that your body is not changing. There may be times when you will see a loss in inches (clothes will fit loser or you might drop a waist size or two) but not in pounds on the scale. Be patient. If your “stall” continues for an extended period of time then you may need to take a look at some things such as your diet or your exercise regimen. It’s important to remember that weight loss surgery is about looking at the picture as a whole and the number on the scale is just one piece of that picture. We measure success by many marks. Ask yourself these questions: 1) Am I moving better? 2) Do I have as many aches and pains in my knees, legs, feet and other joints? 3) Have I seen a decrease in my medicines that I have to take? 4) Have I lost inches? We all get wrapped up in that number on the scale but do not let that discourage you or sway you from your resolve.
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Not necessarily. Again, you will find that as you move farther and farther out from surgery it will be easier to swallow some things. However, there may be some particularly large pills that will require you to break and/or crush them or seek a smaller alternative.
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Please send your question to us at AskTheNurses@georgetownbariatrics.com.
Ask Dr. Sonnanstine
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A Tubal Ligation (tube tying) can be performed at the same time as your Weight Loss Surgery. However, it is up to the patient to arrange this with a Gynecologist that is willing to do their surgery at Georgetown Community Hospital.
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Patients will typically begin to feel restriction in their Realize Band after the 1st or 2nd fill. Most patients reach the "sweet spot" with the Band after their 3rd or 4th fill. It is important to maintain close attention to your Band and have regular follow-up with Dr. Sonnanstine in order to optimize the restriction that your Band provides and, ultimately, your weight loss.
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Having had prior Hernia surgery with mesh does not eliminate the possibility of undergoing any types of Weight Loss Surgery.
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Hiatal Hernias will be fixed, as necessary, at the time of Weight Loss operations.
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Crohn's Disease eliminates the possibility of a patient having Roux-en-Y Gastric Bypass and Sleeve Gastrectomy surgery. Laparoscopic Adjustable Gastric Band Surgery (Realize Band and Lap-Band) is possible, however.
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I have Rheumatoid Arthritis and take steroidal medications. Does this affect my ability to have wls?Having Rheumatoid Arthritis and/or taking steroid medication does not eliminate the possibility of undergoing any types of Weight Loss Surgery. Steroids and Immunosuppressant medications must be stopped for 7-14 days before surgery, depending on which operation is being performed.
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Taking Plavix and/or aspirin does not eliminate the possible of undergoing any Weight Loss operation. However, Plavix must be stopped for 7 days before Gastric Bypass and Sleeve Gastrectomy surgery and permission to do so must be granted by the patient's Cardiologist. Band surgery can be performed without stopping Plavix.
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For patients who have had multiple abdominal surgery, there will be a slightly higher chance that the operation may need to be performed through an open incision if an attempt at performing the surgery Laparoscopically is unsuccessful. Despite the claims of some surgeons, it is impossible to have a perfect 100% rate of performing weight loss surgery Laparoscopically.
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Roux-en-Y Gastric Bypass surgery has a profound impact on Type II (Adult-onset) Diabetes. For reasons not completely understood, but believed to be secondary to the metabolism-changing effects of Gastric Bypass, improvements in Diabetes occurs almost immediately after surgery is performed. Approximately 90% of patients who have had Diabetes for 5 years of less and 50% od patients who have had Diabetes for 10 years or longer, can enter complete remission from the disease and may stop taking all Diabetic medications.
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Please send an e-mail to Dr.Sonnanstine@georgetownbariatrics.com.