Pre-op testing, from referral to anesthesia

Nov 02, 2011

Below is a post from my blog: www.chunkymonkey6491.blogspot.com. Please visit!

 I thought that it might be interesting for those considering surgery or on their way to getting the sleeve or any other type bariatric surgery to see what I went through from start to finish. I must say, as a disclaimer, that you insurance company or surgeon may have different requirements which may include more or fewer appointments. I also had a time constraint-- I'm a student and wanted at least 3 weeks to recover before going back to school, so my "journey" was on the fast track a bit. Some doctors recommend taking longer to go through this process so that you can mentally prepare for the surgery since it will be permanent and you'll definitely want to be sure that this is something you want to do. I've included a timeline so you can see how long it took me.

May 14: I met with my primary care physician to get a referral letter. My doctor is kind of kooky and opened the door dramatically (the nurse had told him why I was there) and said "We're reach a critical mass!!" which I thought was an ironic turn of phrase. Most, if not all, insurance companies require a letter of medical necessity from a primary care doctor before you can be approved.
May 26: Another required event for any larger weight loss surgery center is a Weight Loss Surgery Seminar. In my case, the surgeons all spoke with a corresponding slide show. It was very informative, but being the control freak I am, I already knew most of what was presented, but it was interesting to see the other people considered bariatric surgery. Most of my experiences concerning this surgery had been online, so seeing morbidly obese people, people like me, en masse was intriguing.
May 31: This was my first cardiology consult. They had meant to have my first appointment be with a surgeon, oops. They did an echocardiogram which involved being naked from the waist up and wearing a very stylish paper vest that didn't quite close. You get to lay on a table, on your side then your back, and they push a hand held thing that looks like what they give pregnant women ultrasounds with (for all I know it's exactly the same thing), and they rub your chest to look for any abnormalities that may make it unsafe to undergo surgery. All in all it was the beginning of a series of tests that made me uncomfortable, but the whole time I just reminded myself that the ends would justify the means and I would never have to see these people again.
June 17: My next test was a stress-test echocardiogram which was just attaching electrodes and strapping a heart monitor to and around my chest. Then I just briskly walked on a treadmill which was set on a steep incline. The goal was to get my heart rate to a "target range" which was determined by my age (I believe mine was 170 bpm). This is meant to check your basic cardiac health and will also show if you have any underlying issues.
June 17: Later that day I had my first surgeon consult. They first weighed me in and had me talk to physicians assistant to ask which surgery I wanted and tested me to see what all I knew. Then I got to meet my future surgeon who was very pleasant and, as he proved, had a very good track record. Our consult was brief but I left excited.
June 30: I had my first of two nutritionist meetings. This meeting was with a nutritionist near me, but she was a little unfamiliar with the needs of bariatric patients. She read over a list provided by my surgeon in a flat tone and showed me lovely example of a plastic chicken as a sample of what I should be eating. Please don't be discouraged if you meet a doctor or nutritionist like this, there are always others!
June 30: The H-Pylori test is the easiest of all the required tests. This tests for a bacteria that may be in your stomach which will lead to your surgery being higher risk. It can be treated with antibiotics but needs to be caught before surgery if you have it to avoid complications. You just breath into a pouch. Drink some nasty juice, wait 15 minutes, breath into another pouch. They test the pouches right there and should be able to tell you relatively quickly if you have H-Pylori.
June 30: Another relatively easy test is Blood and Urine samples. It just tests the basics- signs of untreated diabetes, pregnancy, deficiencies, and all that good stuff.
July 1: Preliminary meeting with my Pulmonary doctor. Kind of scatterbrained, but good enough. I was told I would need a breathing test and sleep study to test for sleep apnea (because it's more common with overweight people and it runs in my family).
July 7: The breathing test was awkward but painless. It felt like smoking a hookah, except I was exhaling instead of inhaling. I don't know why but I felt like I wasn't breathing deep enough - kind of a weird thing to be insecure about. They also braco-dilate (I think that's what it's called). They essentially give you asthma medicine to help you breathe deeper if you have the potential to.
July 7: The Psychological evaluation was a weird situation. For me, being obese my whole like I had a thin layer of self esteem and was very nervous about what types of probing questions I might be asked. I managed to run into some I knew there, double awkward, and when I was eventually walked in I tried not to smile as I was asked to sit on the cliche shrinks couch. The questions were pretty straightforward- Tell me about the surgery, do you drink or do drugs?, do you have a family history of mental illness?, do you have friends, and so on. My evaluation was summarized into a very clinical 3 paragraph paper which cost $50, lovely.
July 7: This time I saw a legitimate, well-informed nutritionist who sat down with a group of us and discussed the necessary vitamins and protein shakes. We talked about the different stages of post -op eating and what we should eat as we get farther out.
July 7: This was most likely the worst nights sleep of my life. The sleep test was like being in a weird sci fi novel. They hook electrodes to your arms, head, and legs along with a tube in your nose to monitor your breathing. The put you in a weird, hotel like room with a tiny TV and watch you sleep. Turns out I have sleep apnea! Go figure. Symptoms include snoring, waking up throughout the night, and daytime fatigue- check, check, and check. I had over 140 hypopnias (when your breathing slows) and I woke up 19 times throughout the night. Yay.
July 14: I had to have a repeat stress test because my results were "positive". Apparently a false positive is common in some percentage of women. If the result is true it could mean that you have an issue with your heart but my repeat test was done differently and showed I was fine. You can research it more if you have questions, I'm not very good at explaining it. All I know is that I needed to wear the paper vest again on the treadmill with an audience and that vest does NOT provide proper bust support. Awkward.
July 14: I got to visit my OBGYN to switch from the birth control pill to the Depo Provera birth control shot. The pill has hormones that might make you more prone to blood clots. You are generally not allowed to take the pill for a month before and after the surgery. Although weight loss makes you extra fertile and the pill may not be absorbed right - so I'm opting to stay on the Depo shot until I finish losing weight.
July 14: You are generally required to go to at least one Support Group meeting before the surgery. There was a good mix of pre-op and post-op people. The pre-op people were all anxious and excited and the post-op people were all giddy and self-assured (most flaunted "before' pictures). It was a good experience and I've been trying to go to another one.
July 19: All of my paperwork was FINALLY sent to my insurance carrier.
July 21: Second sleep test. Same procedure as the first one but this time I had to wear a sleep apnea mask to test me to find the right pressure for me during the surgery. People with sleep apnea are more likely to have dangerous respiratory events post surgery, especially if the pressure isn't right during surgery. Regardless, this night was m.i.s.e.r.a.b.l.e.
July 21: Was APPROVED by insurance. Set surgery date.
July 28: Pre-admin test. Includes paperwork, checking out your heart, drawing blood, and other basics.
July 28: Pre-op class. We discussed in detail everything that would happen directly before, during, and after the surgery as well as what our eating would be like for the future.
August 2: Started 2 day pre-op liquid diet.
August 4: Surgery day!


I hope this answered some questions you might have. Feel free to leave comments below if there's anything else you want to know about my pre-op test experience!

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