Since we talk about a "DS IQ test...."

Again, remember that the focus of this project/exercise is NOT the patient, it's the ASMBS pros. I'll throw in a few fast comments to your questions that might influence further thought, given that I'm no doc or scientist (hello docs? Help please?).....

1.  The malabsorptive component is made up of 3 sections.  What are they?

Clarify please? Which malabsorptive component and what sections?
     
2. What is one advantage of removing part of the stomach?

Um.....I'd want to clarify this to vertical vs. horizontal gastrectomy, I think, or maybe otherwise expand on it to clarify better the difference between pouch and gastrectomy...kinda making it more idiot proof I suppose.

3.  Lack of proper dosages of vitamins will cause deficiencies.  What types of vitamins require increasing and what symptoms would you experience if you were deficient?

I'd want to break this down, I think, into maybe fat soluble, water soluble vitamins and other micronutrient. Or maybe other folks can come  up with a better way to expand on this question?

4.  Oil based vitamins are OK to use.  True or False?

And why?

5.  Possible side effects of the DS are:
     a) dumping syndrome
     b) diarrhea
     c) hernia
     d) both b & C
Good start on a multiple choice section, IMO needs expanding. Help anyone?

6. What part of the DS absorbs the proteins and sugars?

Not DS, digestive tract. Expand here please, folks who understand anatomy better?

7.  What is the purpose of the common channel and what is its function?

IMO there are three channels/tracts in the DS and we need to understand all their functions: alimentary, biliopancreatic, common.

 

Perhaps during the 6 month diet (for surgeons that require it, and people who's insurance requires it), it should be required that the patient also undergo therapy with a qualified therapist so maybe they can catch any behavioral issues that might make them have issues with non-compliance post-op.

You know I'm a big fan of therapy! Let's talk about what would define a "qualified therapist" in this context.

My personal thing is that I would prefer a psychologist (with apologies to the MSW/LCSW folks and acknowledging that I am pursuing the LPC--it's possibly a silly prejudice I have). Can we come up with a body of information/knowledge/help for this area?

When I say qualified therapist, I was thinking someone being able to spot non-compliance issues, liars, disorders that would cause them to have a hard time coping with the post-op life.

They would also have to be trained on the DS and have an extensive knowledge as to what living with the DS is like. I.E. supplementation, protein requirements, water requirements, etc.

Maybe have them administer the psych. eval form tests once a month to spot trending problematic behavioral patterns, liars etc.

I think a psychologist would work, my only thing with psychologist is, don't they only spend a few minutes with you with each visit? Maybe a psychologist/therapist team, that way they can converse with each other.

I think you might be confusing psychologist and psychiatrist on the time issue.

When we talk about "qualified therapist," that's a term that is very nebulous. I don't know of any testing or licensing procedures/instruments that connect psychotherapy and bariatric medicine, though I'd love to hear about any such options that might exist worldwide. Both of those terms, "qualified" and "therapist" are not legally or ethically defined, much less together and wayyy less when we focus on bariatric medicine or psychology.

This means that we could participate in a totally pioneering endeavor, if we could work out "how" to do so, in contributing to developing input into a field of psychology that is, if not nonexistent, certainly undefined. In order to do this, we have to form our thinking to conform to a whole bunch of rules about content and presentation.

So, to go back to your post and shine a little spotlight on your comments: Define these terms: non-compliance issues, liars, disorders that would cause them to have a hard time coping with the post-op life.

Which tests do you think should be administered monthly? Why monthly? What would you want to accomplish by doing this?

I don't know much about this field, but when I mentioned qualified therapist I was thinking along the lines of a therapist that would specialize in bariatric surgery, or a therapist that works with the surgeons office and has been trained by the surgeons office on each procedure and how life will be post-op. That way they can know the right questions to ask when in a session and what answers to look for.

                      I.E.: What will your vitamin regime be? How much protein will you be taking? What are possible complications that can come from surgery? Are you prepared for them? etc

I was thinking that the psychological evaluation test they give you as part of the requirement for bariatric surgery would be the monthly test, not because it has anything to do with bariatric surgery though.

I was thinking this because of the questions I remembered being asked on it. If someone had a habit of lying, they might fill the questions out differently each time. So once a month might help them spot certain trends?

For non-compliance, off the top of my head, I guess they could spot that by the patients behaviors. I.E. them constantly missing appointments, not coming to appointments but one or two times out of the entire 6 months. Certain things said by the patient while in therapy could indicate possible non-compliance.

I would think out of the two, non-compliance would be harder to spot.

As far as what I'd want to accompli****hink that at the end of the 6 months the therapist/psychiatrist could give a report on how the patient responded to therapy, how well they believe the patient understands the risks of surgery and the aftercare of surgery, any potential problems they see for the patient after surgery, if they believe the patient is a qualified candidate for surgery.

Let's see..... I'm now responding here partly as a long term psychotherapy consumer, partly as a long term pastoral counselor (very different from psychotherapist but a tiny bit of overlap) and partly as a student of psychology with emphasis on training as a clinician. NONE of this makes me an expert, except perhaps in asking questions.

(There, was that a clear enough disclaimer? LOL)

There are no parameters in any part of the professional or subprofessional world to indicate a "specialist in bariatric psychology." Doesn't exist. Therapists might CLAIM that speciality, but it's important to understand that they are only declaring an INTEREST in an area, NOT that there is any way to measure or quantify their "specialty." BIG DIFFERENCE.

Surgeons are not in ANY WAY qualified to teach, train or certify therapists in ANYTHING. We're talking apples and beef here. Or maybe apples and uranium. NO connection at ALL. Yes, anybody can learn information about any field and then apply their learning within their spheres. This is very VERY different from talking about "training" or "qualifications" or "specialization," ESPECIALLY in the mental health field.

Those "evaluation tests" that you took at your psych exam.....Um, well, I'm giving away secrets here I suppose, but here's the deal: They are designed to assist a qualified professional in giving hints about overt mental disorders. They do NOT, I repeat do NOT, give diagnoses or replace therapy. They are designed to give a pro a headsup that you might be psychotic or depressed or maybe have schizophrenia or dementia or substance abuse or an eating disorder. Oh, or maybe a personality disorder. I think that pretty much covers the spectrum. That's all they do, and they are not necessarily all THAT good at doing that stuff.

Nothing replaces a good psych interview, and very few psych professionals are any good at the interview.

You remember questions that made you wonder about being caught out in lying. Very good! The MMPI and its sister instruments are indeed designed to catch outright liars, as well as a bunch of other "confabulators" and otherwise inconsistent responders. But those instruments have major limitations. Indeed, the fact that you remember thinking about how the test would catch a liar is a demonstration of limitations. If it was a truly GREAT instrument, it would be a hell of a lot harder to notice that kind of thing.

I agree with you that compliance with any kind of therapy contract is very important, whether it's weekly, daily, monthly, whatever, because COMPLIANCE is important. I don't know if six months is a good enough parameter. I know that in my own therapy process, it was more like six YEARS before I felt safe enough to be moderately open and honest with my therapist, and that had nothing to do with his skill or the strength of our relationship or my honesty level. That's just what it took for me to feel truly safe.

I hope that this illustrates, to some tiny degree, how complex the issue of mental "stuff" is, and why I'm looking for ways to substantiate, quantify and express good parameters that the medical pros might grasp.

I had no idea that when a therapist claimed a speciality, that they hadn't "trained" in it. That's pretty interesting. So basically, when you are in school you learn tools for helping patients with every situation whether it be PTSD to generalized anxiety. That's pretty cool to me.

Yah, the test asked me a lot of really odd questions and it kept repeating them in different ways. I was wondering if it was making sure I was actually reading the test or if I was just marking answers to fini**** off really fast.

I think when I thought of the 6 month duration, it was because it would be at the same time of the diet so the therapist could be involved and help with any problems the patient might have. Not to say that the therapist would act as a nutritionist, but they might could see certain behaviors that the patient has during a "dieting" phase.

On the flip side of that though I get what you're saying about the honesty level and people taking a while to get used to their therapists. I didn't think about my own therapist and how long it took me to feel comfortable, I just thought about how I am comfortable right now.

It does illustrate how complex the mental stuff is. I have no idea how to incorporate any of my ideas now, but I've learned a lot. :)

There are certain kinds of "specialities" within clinical therapy work, but when people talk about, say, eating disorders, PTSD, bariatric surgery, etc.....They are declaring an area of special interest and preference, and they have probably focused quite a bit of their continuing education (and maybe also research) on that area. But it's not the same as, say, a board certified endocrinologist compared to a family medicine specialist or a hospitalist.

In school we don't really learn too many tools. We learn lots of theory and kinda sorta get started in the applications. But it's quite a lot later, in clinical training, that the "hows" and the "tricks of the trade" get learned.

 So this may not be therapy, but My insurance required a 6 month diet. I went through my surgeons office as they have a medical weight loss program. I had to attend once a week, turn in a weekly calorie consumption, weight check, and a weekly class alternating between Exercise, Behavior, and Nutrition. At first I seen it as a huge inconvenience but now I am glad I did it. I really did learn a lot. It was interesting. So I would have to agree with you. At least some kind of Behavior class.