My pre-op experience including psych evaluation - long post

I'm more of a reader than a poster or responder, but hope to be more active as my journey progresses.  

A huge thank you to all of you who share, especially the vets! It's crazy how alone we fell in some of our struggles (yet keep posting the same questions over and over).

I'd thought about WLS but not until last fall when my counselor and doctor recommended the procedure and following and old friends success on FB did I start my research.

My hospital had a mandatory info session as step one. I was one of three people when it started and about a dozen made their way in after the presentation started. A nurse presented an overview of the types of surgery and fielded questions. It felt like a bit like an infomercial - very safe, we handle all the insurance and you come out the other side skinny. I attended the session in early dec '13. 

I filled out a lengthly intake packet (late dec) and was told I would be scheduled for 2 days of meetings, 3 meetings each day. I understood this to be education and training for me about how to prepare for surgery and what to expect afterwards.

Reading through old OH posts, I had a list of questions ready. 

Day one was the psychologist, a weight loss doctor (not a surgeon) and a nurse (mid Jan) 

In my research, the psych eval was the only thing I hadn't looked into.

My only concern was my depression holding up my surgery. I was taken aback as the psychiatrist appointment was zero percent education and 100% looking for potential risk factors. My psych does wls 1/2 time and substance abuse/alcoholism 1/2 time. I held nothing back - including my alcohol use. I sent up a bunch of red flags, was told I might be required to abstain for 12 mos before they would submit my insurance claim, and earned myself a follow up visit :(  

The weight loss doctor took my medical history and wanted me to start exercising before surgery. 

The nurse repeated the same info at the information session (with out taking a breath) and took my picture. She is supposed to be my main point of contact but I haven't talked to her since then. My hospital also does and ekg during this visit.

I went back to take the MMPI due to concerns my psych had (feb)

The 2nd set of appointments (also feb) included a 2nd visit with the weight loss doctor, a personal trainer, and the nutritionist.

The weight loss doctor didn't really do or say anything of value. She talked a bit about vitamins post op and said that's the last time I would see her.

With the trainer I walked for 10 minutes, they measured how far I walked and took my heart rate and oxygen levels. The rest of the meeting was various exercises moving my arms w/o weights for 60 seconds at a time. As a former athlete who has used trainers, this was unhelpful and offered no instruction about how to exercize post op. (Again, thanks to the vets (Keith and others) for sharing tips and routines) 

I brought the nut a 3 day food journal. (oh, I got this fancy binder of about 100 pages that I had to bring to each meeting - the food journal was part of this. She told me my insurance required 6 mos of meetings before approval. I started month one on eating 3 meals a day, no soda, and no fast food. No conversation about eating post op.

Two weeks later I was back for the 1st of the 6 required visits. I brought 2 weeks worth of food journal. In those two weeks we discovered my insurance didn't actually require 6 mos (or any) nut visits. However, my nut said I had to come back at least once more...4 more weeks of a food journal. Goals - no water 30 minutes before/after eating, chew all food to applesauce consistency, all meals sitting at a table w/o a computer/tv, and all meals homemade w/protein (no boxed/canned/frozen dinners), and an exercise log.

UGH - I follow instructions perfectly. Dropped 15 lbs during our 2nd visit. Finally, after reviewing my eating over those 4 weeks, I passed evaluation and was told that we would meet again before surgery to talk about a pre-op and post-op diet. I went from the nut office to the psych's office for appt #2. She was happy with the update from my nut, said my mmpi results were great. No substance alerts (nor any depression). From what I took, depression is not a concern entering surgery but the other factors you can read about here (relationships, binge eating, cooking for family members, etc.. are concerns. I cleared up the concerns over my drinking - i.e. I drink alone because I live alone and don't drink and drive. I drink to excess, in part because a 400 lb guy can drink a lot, but excess to me means NOT passing out, not missing work, and not throwing up. That I switched from beer to hard liquor because that's what I use to drink but couldn't afford it for a while and tend to sip a glass vs drink beer in volume.  

I didn't like that my doctor and counselor who knew me well thought I was a good candidate and my personal research and reflection I was ready to commit to wls, but was subject to all of this evaluation before they would submit my claim. I was a bit frustrated that the nurse and weight loss dr said studies showed that the 6 most of nut visits don't impact post op success rates - but still had extra visits with their nut. Also 3 or 5 insurance errors were frustration, but I reminded myself to give these professionals the benefit of the doubt and keep in mind they are looking out for my best interest. 

The recommendations from my pcp and counselor along with my food journal success and mmpi have mostly cleared the way. The psych said the team would meet to review my application and if/when approved submit it to insurance with their findings/recommendations.  I had stopped drinking about the time I went to the info session but the psych said she "might" recommend a two month wait before submitting to my insurance company. 

After insurance approval I finally meet the surgeon, have a pre-op physical, and the meeting with the nut to get my pre and post-op eating plans.   The nut did say the pre-op diet is 10 days of liquids - I think that might be the hardest part of the entire process.

Good luck to all of you in obtaining surgery, losing the excess weight, and keeping it off!

your process was not unlike mine.   my insurance did require the 6 months with a nut, but everything else you had to do is part of the routine at "center of excellence" bariatric centers.  they evaluate your ability to be successful and compliant after surgery.  meeting with the bariatrician before surgery is to make sure you are healthy enough for anesthesia and to identify any medical barriers.  meeting with the psych is to make sure your underlying causes of obesity(for young women they really dig into if you were abused...) depression, anxiey, and body image issues are all barriers to being successful, they evaluate you to see if there is anything you need to work on before surgery.  yes it felt like a pita, but i see the value in it.  the concerns about alcohol are b/c people that have wls are at risk of addiction transfer, if you cant have food, you might turn to alcohol.  

yes, the process is involved and frustrating, but there are valid reasons for it.  you could just go to mexico and have no pre or post care if you wanted...but i think these bigger clinics with all their requirements have value for helping have long term success.

the 10 day liquid diet does suck, but if you do it, your liver shrinks and the surgeon can see your stomach better and you have a safer surgery.

good luck!

Yeah, for whatever reason, I wasn't ready for the poking? The cutting yes!

However, learning why I choose to over eat interests me.

Onward to the education phase!