Question:
Is it strange that my dr did not require a physc eval or to see a nutritionist...?
My surgery is less than 2 weeks away and I am beginning to wonder about something. When I had my consult, the dr did not require a psych eval, to see a nutritionist, or anything else. All I am doing is my prereg on the 18th. I see where others have posted and had to go through all that..even a sleep apnea test and much more. Should I be concerned or is it just up to the individual dr and insurance as to what is required to have done? Thanks! — dixieb (posted on February 12, 2003)
February 12, 2003
I had my surgery on 9-30-02 (-79 pounds) and did not have a psych eval or
nutritional consult. I had an ekg and urine test. That's it. I think it may
depend on your insurance, bmi, and relative health.
— Lesa H.
February 12, 2003
Hi there, Dottie! Like you said it depends on your surgeon and insurance.
My surgeon normally wants a psych test done, but since MY insurance didn't
require it, he said that was fine. He told me a lot of insurance comp. do.
He requires us to see a nutritionist post-op a few times and then as
needed. And most of the time the surgeon has all the information from your
PCP and if you have no documentation of sleep apnea, why should we get
tested for it? Don't worry about it and congrats on your upcoming surgery!
Vi. open RNY 9/23/02 down 105 lbs.
— Vi F.
February 12, 2003
I see that you have a PPO, I have one also. You do not need a referral to
go see a surgeon, nor do you have to have a psych eval or a nutritionist.
I'm sure you can request to go see them, but I don't think it is necessary.
I hope that answered your question! Take care!~~~~Debralee
— D S.
February 12, 2003
Hi Dottie- As for me, my Surgeon/hospital had me fill out a many-paged
questionnaire after a mandatory support group visit where the surgeon
outlined the surgery and then patients (post and pre-op) stayed afterwards
to have their regularly scheduled meeting. Sorry, I didn't keep copies of
the questionnaire -but when I was filling it out I felt it was really basic
and didn't need to keep copies. I do remember it was long- and most of it
didn't apply to me. After that, I was lead right to surgery (faster than
others) after a ekg, ultrasound and bloodwork. I did answer everything
truthfully. But still, since reading this site up and down I asked him
flat out WHY I didn't need the psyche eval. He said it was how I answered
my questions. So, I assumed it was because I had no eating problems or
mental disorders red flags to be dealt with.... I did get to meet with
the nutritionist after surgery during my routine check-ups to ask anything
I wanted (and had their phone number on case of emergencies), but nothing
else was mandatory (they give out a many-paged booklet on what to follow
after surgery and also have a support group if you want to go). If it is
free or relatively cheap- I would highly recommend therapy (or the support
group) during your first year out- cause I feel it is warranted in 9 out of
10 patients. This site is also very, very helpful.
— Karen R.
February 12, 2003
I know some of the previous posters have not had those tests either, but I
think the Sleep Study should be done. The memorial page here on this site
has people on there who didn't have Sleep Studies and died during their
recouperation because their Sleep Apnea went undiagnosed. I'm not trying
to scare anybody, but it's better to be safe than sorry. Also, you want a
surgeon who is committed to your aftercare. If they don't require you to
see a Nutritionist before or after surgery, I'd really question whether
he's there for your best interest post-op. Take care & good luck.
— thumpiez
February 12, 2003
I did have sleep apnea and I probably should have been tested- but wasn't-
because nobody knew, including myself! Now that it is gone I realize HOW
serious it was, and how bad I had it- if anything, ASK for that test. My
Mom alwaay said I sounded like I was choking when I slept, and I never felt
rested. My first night in the hospital after surgery, my nurse said I
stopped breathing a couple of time- scary stuff! I had NO IDEA until I put
two and two together! While it's gone now;, it doesn't HURT to tell your
surgeon your fears!
— Karen R.
February 12, 2003
Hi!! I am almost 1 year post op. I also now work for my doctor. He has an
Obesity Center.....We require EVERY PATIENT to meet with our Psychologist
and Nutritionist. Every patient has a complete physical, including
bloodwork and an EKG. Every patient has an Upper GI, Chest X-Ray, and an
Abdominal Sonogram (if they still have their gall bladder. Many patients
that have more serious health problems are required to have a cardiac and
pulmonary clearance by those specialists. I believe all of these are
SOOOO important and cannot imagine a doctor not requiring these. This is
major surgery...... Also not meeting with a nutritionist?? Why wouldnt
you? Obviously patients who find themselves in need of this surgery
probably need to learn new eating habits. Being post op myself, If my
doctor doesnt have a nutritionist to send you to, I STRONGLY recommend that
you find one on your own.
— Mandybub
February 12, 2003
I had my surgery on 1/23/03. I didn't have to see a nutritionist of have a
physc eval.
It not only depends on what your physician requires but it also depends on
your insurance company. I have Blue Cross Federal, my husband is a Federal
employee, and they do not require these. I also have Tricare, my husband
is retired military, as my secondary and they didn't require these either.
My physician did have a nutritionist see me while I was in the hospital to
talk about my new way of eating.
— Sharon M.
February 12, 2003
I'm sorry and don't want to scare anyone but I just can't imagine going
through something so serious without having more thorough testing done.
Many people do not realize their issues with food. I can understand a
psych eval not being mandatory, but would want to talk to one anyway.
As for a nutritionist, that too, may not be required pre-op, but should be
seen afterward. Don't we all REALLY know what we should be doing? But do
we do it? I know I don't (still pre-op). If I did, I wouldn't be having
the surgery.
But most of all, I can't imagine not have the sleep test. I had no idea at
all that I have sleep apnea. I was even skeptical after the test until they
showed me the numbers and the video. OMG. I'm dreaming of what it will be
like to TRULY sleep after the surgery.
During other testing I learned that I only a 82% oxygen absorbtion. Not
all the time, but often enough that I will be in ICU after surgery.
My main thing is, if I'm concerned about something I want the answer BEFORE
surgery.
Best wishes!
— Diane S.
February 13, 2003
I did not have to have the psych eval, but the surgeon now requires that of
all patients, as well as mandatory attendance at 2 diet classes by a
Registered Dietician, a support group meeting and cardiac and/or pulmonary
clearance. It doesn't make any difference if your insurance requires it or
not - HE does, so you have to do it in order to be considered for surgery.
How the heck are you supposed to know what to eat after you get home? I
don't mean to scare you, but this surgery is a permanent, life-altering
event and I think everyone needs to be as prepared and safe as possible
before undergoing WLS.
— koogy
February 13, 2003
Personally, I think the psych exam is a waste of time. The dietician is a
good idea, because somebody should give you a clear written diet and
vitamin plan for your first post-op weeks so you KNOW what you can or
should have (or shouldn't). My pre-op testing also included a chest x-ray
(showed nada), a gallbladder sonogram (showed gallstones, so the
gallbladder came out during my RNY, thus saving me pain and another surgery
down the line), and an upper GI series -- the barium-drinking test -- which
showed I had a hiatal hernia (didn't correct that, but VERY useful to know
since it connects very closely to my pouch). Without the pre-op testing, I
would've had no idea about the gallstones or the hiatal hernia. I'm VERY
glad that testing was done.
— Suzy C.
February 13, 2003
My dr. did not require a psych eval or sleep study either, I did meet with
a nutritionist on my preop testing day and also in the hospital to review
the plan. My dr recommended I attend support group prior to surgery and I
did because of my own commitment to making the best of my surgery. If you
feel you need a psych eval , maybe you are not sure this is the right thing
for you. In fact I think most normally intelligent people can tell a psych
what they want to hear to get surgery with out addressing their real
feelings and fears. I question the usefulness of a psych eval. I know a
girl who was required to have one and the psych said she was not a canidate
for surgery because she overeats... DUH???? So there is a lot of ignorance
on the part of psychiatrists. I did not feel a strong need for a sleep
study even tho I had thought I might have sleep apnea. i felt strongly that
losing weight will do more for the sleep apnea than any thing else. My
husband sleeps with a cpap and that will not do for him what
losing weight would. Over all I think consults should be based on your own
medical history, If you have a lot of health issues , history of mental
illness, depression etc. GOOD LUCK!
— **willow**
February 13, 2003
Dottie:
Regardless of the other pre-op appointments, I think that you definitely
should consult with a clinical nutritionist familiar with WLS to assist you
in post-op dietary issues and to keep track of your blood nutrient levels.
There is too much risk of malnutrition if you aren't careful. Many
surgeons follow up with their patients diet after surgery, but they really
aren't trained in this field. My nutritionist has been an invaluable
resource to me.
As far as sleep apnea testing, if you don't have the symptoms of apnea,
that might be why you aren't being tested. I never had that test either.
My psych eval was only a requirement of my insurance company, not my
surgeon. If your insurance doesn't require it, I wouldn't worry. If you
feel you need to talk to someone about food issues pre or post surgery,
then you can contact a therapist and arrange an appointment.
Best of luck to you!
Michele
— Michele C.
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