Frequently Asked Questions
General Questions
Insurance FAQ’s
Nutrition Questions
Bariatric Behavioral Health Services
Pre-Surgery Scheduling Questions
Ask the Nurses
Ask A Surgeon
General Questions
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The Bariatric Center at Georgetown Community Hospital (Georgetown Bariatrics) does not have a Program Fee. However, all patients should contact the Surgeon's Offices affiliated with our program to see if their programs have additional out-of-pocket program or administrative fees.
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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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It’s important that you take enough time to adjust physically, mentally and emotionally to your new lifestyle, and to heal and recoup energy and stamina following surgery. It’ll take time to learn how to eat again, as your recovery eating schedule takes at least 4 weeks to get back to regular foods. Often, depending on the patient, it takes longer. Giving yourself the gift of adequate time and focus on your recovery allows you to fully prioritize the new healthy lifestyle changes you are trying to build and sustain. However, we recognize that everyone’s circumstances are different, and this is a flexible process. Your surgeon and his staff will work with you to plan the ideal time for you to return to work.
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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 a sticker with a dove. When you see these stickers , you can immediately be assured that peice of furniture is safe for 300 pounds at minimum. By looking closer at the label, you can see that each one has a number on it. Add a zero to the end of that number, and you have the capacity of that furniture. For example, a dove sticker with a 50 on it is safe up to 500 pounds.
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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Yes. Anyone who loses a significant amount of weight is going to have some degree of excess, or loose, skin, no matter how fast or slow the weight is lost. The amount of loose skin that you have will depend on many factors, such as how much weight you lose, age, race, how your weight was distributed and gender.
What you need to remember is that excess skin is not a big deal, in comparison to the many health and quality of life gains of successful weight loss. We typically see that 1-2 years after surgery, patients have lost their weight, have much more energy and are out there living life doing and things they haven't been able to do in years. They are loving life again. Do they have excess skin? Yes. Do they care? Not one bit. The excess skin is under their clothes, no one can see it and the vast majority of patients are not bothered by it. They realize that they look much better in clothes, and their newfound self-confidence shines through.
However, if you choose to have skin removal surgery in the future, we will help you find a plastic surgeon. Please note that plastic surgery is often not covered by insurance, is invasive and involves varying risk, depending on the procedure(s) performed. Consider carefully all risks, benefits, recovery time and out-of-pocket cost before deciding; you may wish to pursue more than one surgical opinion.
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All of our patients complete our Preparation Program, which encompasses Pre- and Post-Op Psychological and Nutritional components, such as evaluations and education.
At this time, there is no cost for the Preparation Program at Georgetown Bariatrics.
Our Preoparation Program Includes the following:
Pre-Operative Visit #1:
· Psychosocial Evaluation/Consultation with Behavioral Health Provider
· Group Education: Surgery and Program Overview
Pre-Operative Visit #2:
· Nutritional Evaluation with Dietitian
· Group Education: Nutrition and Lifestyle Changes
Final Pre-Operative Visit:
· Anesthesiology Consultation if indicated
· Behavioral Health and/or Nutritional pre-surgical follow up if indicated
· Group Education: Pre-Operative Preparation Class
Other requirements:
· Group Pre-Surgical ‘Psychological Readiness for Weight Loss Surgery’ Class
Post-Operative follow up First Year
· 2-week Post-Surgical Group Education, weigh-in; and if needed, individual provider appointments (no charge)
· Behavioral Health Provider : Up to 2 additional Individual Post-Operative Visits (no charge*)
· Dietitian: Up to 2 additional Individual Post-operative Visits (no charge*)
· Support Groups: Regular Group Meetings, Online Patient Forum, E-newsletter , etc. (no charge)
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Pregnancy after Weight Loss Surgery is very possible. In fact, women who have suffered from infertility in the past will often regain their fertility as they lose weight. However, we recommend that our female patients avoid pregnancy for ideally at least 18 months to two years after Weight Loss Surgery – specifically with Gastric Bypass and Gastric Sleeve. The reasoning behind this is that periods of rapid weight loss are not the ideal situation for nourishing a growing fetus.
However, after you’ve gotten past your first two years, have lost the bulk of your excess weight and are successfully maintaining, pregnancy is much safer for both you and the baby, as you will be lighter, more active and healthier all around. In addition, you will have a lower risk of weight-related pregnancy and delivery complications, and the baby, if born at a healthy weight, will have a lower risk of later health problems as well. If you become pregnant, please let us know as soon as possible because we’ll work closely with you and your OB-GYN to make sure you don’t become vitamin or mineral deficient during the pregnancy.
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Please send an e-mail to [email protected].
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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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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Please send an e-mail to [email protected].
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 [email protected].
Pre-Surgery Scheduling Questions
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PFT (Pulmonary Function Test) This breathing 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 tests are only good for 45 days, so unless you have specifically been told to have one or more of these tests 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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It’s important that you take enough time to adjust physically, mentally and emotionally to your new lifestyle, and to heal and recoup energy and stamina following surgery. It’ll take time to learn how to eat again, as your recovery eating schedule takes at least 4 weeks to get back to regular foods. Often, depending on the patient, it takes longer. Giving yourself the gift of adequate time and focus on your recovery allows you to fully prioritize the new healthy lifestyle changes you are trying to build and sustain. However, we recognize that everyone’s circumstances are different, and this is a flexible process. Your surgeon and his staff will work with you to plan the ideal time for you to return to work.
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Please bring those to your consultation appointment with the Surgeon and give their staff.
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Send an e-mail to [email protected].
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 an e-mail to [email protected].
Ask A Surgeon
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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 need on average 10 or so adjustments to the band, usually within the first 18 months. Your first potential adjustment begins approximately 4 weeks after your band surgery (your first follow up visit). Regular follow up (approximately every 4-8 weeks) is critical to long term success.
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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. Sleeve gastrectomy may be performed in selective cases. Laparoscopic Adjustable Gastric Band Surgery (Realize Band and Lap-Band) or LGCP is possible, however.
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I have Rheumatoid Arthritis and take steroidal medications. Does this affect my ability to have wls?
In most instances, Roux-en-Y gastric bypass should be avoided although can be performed on a selective basis. The Sleeve is a possibility if you can avoid all anti-inflammatory medications and steroids for 6 weeks after surgery. Having Rheumatoid Arthritis and/or taking steroid medication does not eliminate the possibility of undergoing Laparoscopic Adjustable Gastric Banding or LGCP. 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 greatly increases the risk of pouch ulceration after RNY gastric bypass and the bypass should be avoided. The Sleeve is an option if patients can remain off aspirin and Plavix for 6 weeks after surgery. Aspirin and Plavix are not a problem with Adjustable Gastric Banding or LGCP. Aspirin and Plavix must be stopped 7 days prior to any weight loss surgery. Whenever aspirin or Plavix is stopped, it must be under the supervision and approval of your cardiologist.
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Generally this is not an issue and your surgery can be done minimally invasively.
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Weight loss 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 the surgeries, rapid improvement or resolution in Type II diabetes is seen with the bypass and sleeve, often within just a few days to weeks after surgery and before significant weight loss. Approximately 90% of patients who have had Diabetes for 5 years or less and 50% of patients who have had Diabetes for 10 years or longer, can enter complete remission from the disease and may stop taking all Diabetic medications. “Cure” is not exactly the right word, and “remission” is more appropriate as weight regain and other factors can lead to recurrence of the diabetes. Type II diabetes is also significantly improved or cured with significant weight loss. Randomized prospective studies have shown significant benefit and resolution of diabetes with Adjustable Gastric Banding, but it is dependent on weight loss. Early data on LGCP show also show similar improvement or resolution in Type II diabetes.
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Please send an e-mail to [email protected].