Cousin has Medicaid and was approved immediately

[summerset 5,261]

@Aggiemae: Obviously you don't have that kind of information. Who would have thought?

[shedo82773 1,236]

My post wasn't just about the preop it is also about the support we all have now. Preop and Postop!! It is so better now!!

[Aggiemae 739]

@Aggiemae: Obviously you don't have that kind of information. Who would have thought?

@Aggiemae: Obviously you don't have that kind of information. Who would have thought?

@Aggiemae: Obviously you don't have that kind of information. Who would have thought?

OBVIOUSLY? I have a master's in social work (Rutgers) a BSN

(Sandford) and a doctorate in nursing (Oregon Health Sciences University) I've been a nurse for 40 years and high risk nursing case manager for 30years. Since getting my doctorate 12 years ago a full time patient advocate and (unfortunately) spend countless hours at case conferences. I just don't respond to bitchy OPINIONS, especially since my original response was completely benign. There is plenty of published research. As soon as one of the "experts here posts a link to research proving they pre operative education DOESN'T effect outcome I'll post links.

[ShelterDog64 2,364]

I am sure that's true in some cases but based on some of the questions and comments posted on this site (for example: three days post op can I eat sausage?) there are many people who don't give this nearly enough thought before they have major abdominal surgery that will require a life time of commitment.

And I am sure a lot of them had to wait months for surgery and had to go through pre-op programs to get approved. Or is there any evidence they all had no or only short waiting periods?

This is what I was thinking, summerset. I'm unconvinced that waiting time correlates to education and then to success. I moved very quickly through our pathway, about 60 days start to finish. I learned very little from the slew of classes, appointments, meetings, etc. that I didn't already know from my extensive research, prior college education and self-education. I spent those 60 days seeing the same people, some of whom absorbed a great deal and some who might as well have skipped the whole thing, judging by their attitudes, questions and issues during post-op support group meetings.

I think some people are learners and some aren't...you could have a year of classes and there will still be those who eat fried chicken on their way home from the hospital.

[ShelterDog64 2,364]

According to my Dr the follow up on the surgery performed before establishing the full service (PT, NUT, PSCH) bariatric clinic found that 80% of the patient regained most or all of their weight at the five year follow up. The four year out data for patients getting comprehensive pre op care show that about 50% still real n some weight 25% still regain at least 50% of their weight but 40% are still at or BELOW goal The goal is BMI of 27 or less, so still overweight.

Link to full paper?

I read something similar to this in SOARD, which is the journal of the American Society for Metabolic and Bariatric Surgery. But it didn't address time between decision and surgery, it addressed education between the same. I think sometimes people decide that time = education when that's not necessarily the case.

There are differences of opinion about practice norms across the entire spectrum of healthcare, but there are known best practices as well. For example, our bariatric surgeons implemented an educational pathway in response to studies that showed improved outcomes in well-educated patients. They've also discontinued routinely having patients do pre-op liquid diets, as there is no evidence of improved outcomes by doing so. These are considered best practice decisions, but they also have some silly things they've left in our post-op instructions, like not using straws post-op.

My theory is that people give up on surgery due to the waiting periods and some of them actually die.

This is the preferred outcome for most of for-profit healthcare, unfortunately.

[ShelterDog64 2,364]

According to my Dr the follow up on the surgery performed before establishing the full service (PT, NUT, PSCH) bariatric clinic found that 80% of the patient regained most or all of their weight at the five year follow up. The four year out data for patients getting comprehensive pre op care show that about 50% still real n some weight 25% still regain at least 50% of their weight but 40% are still at or BELOW goal The goal is BMI of 27 or less, so still overweight.

Link to full paper?

Been a smarmy bitching long?

Good GRIEF, she asked for a link to a paper and you call her a smarmy bitch? What the hell???

[summerset 5,261]

I think some people are learners and some aren't...you could have a year of classes and there will still be those who eat fried chicken on their way home from the hospital.

I don't think that "harmful eating" has necessarily to do with a lack of education. Yes, some people might actually be too dense to realize the danger of this or are maybe not educated enough (though I somehow have problems imagining this) but I think the reason people are doing this is not being able to resist the call of their addiction.

You can educate people about this or that until you're blue in the face - when addiction is calling, it's all futile.

I think when talking about "not being educated enough" or "being stupid" we all should remember that we all needed surgery because we weren't able to practice what was preached. All that education about nutrition, coping with cravings etc. was futile in some way or at least not enough.

I don't know how to deal with patients who have an addiction as strong as causing them to engage in really harmful eating behaviors in the healing phase. I guess maybe they should not have had surgery in the first place at the current stage of their addiction. However, I feel awkward making a statement like this, it feels too judgmental.

[summerset 5,261]

I read something similar to this in SOARD, which is the journal of the American Society for Metabolic and Bariatric Surgery. But it didn't address time between decision and surgery, it addressed education between the same. I think sometimes people decide that time = education when that's not necessarily the case.

Do you have a link to the original paper they're referring to? I did a quick (means half-hearted) search for papers but couldn't find anything that was able to answer my question. If I learned something regarding articles dealing with medical topics it's this: always look at the original papers!

What I'd really like to know is:

Does a long-term pre-op education combined with a proper post-op care compared to a rather quick pre-op education combined with a proper post-op care really make a significant difference in the outcome 5 years or more after surgery?

There is such a big hype about the pre-op programs, but lets face it: they cost time and money (I can only talk about Germany here).

I think my displeasure with the required pre-op programs boils down to this: if they can really teach you something new about nutrition, exercise or coping skills in a 6 months program - you didn't have the proper education in the past and are not eligible for surgery in the first place as you didn't try everything else and failed.

If pre-op education is only about what to eat and what to do after surgery (like liquid phase) - you don't need an extended time period for this kind of information.

---

ETA: this "tried everything else and failed" is required for getting approval in Germany

Edited November 14, 2016 by summerset

[ShelterDog64 2,364]

@@summerset If I can lay my hands on the study (and I'm not even sure it was a full study, it may have been an abstract) I read, I'll cite it. Our medical library did a literature search and printed it for me, it's somewhere in the mass of papers I accumulated during my self-education re: sleeve/RNY/DS. Seems to me I couldn't get to it on the non-subscription site.

It didn't address post-op care at all, just pre-op education, iirc.

[summerset 5,261]

@@ShelterDog64 That would be nice.

[ShelterDog64 2,364]

@@summerset ** don't know how to deal with patients who have an addiction as strong as causing them to engage in really harmful eating behaviors in the healing phase. I guess maybe they should not have had surgery in the first place at the current stage of their addiction. However, I feel awkward making a statement like this, it feels too judgmental.**

I don't think it's judgmental when you can see the failures we see every day here.

Maybe it's the difference between just lack of willpower and true food addiction...the sleeve has been enough, at least so far, to facilitate the cure of my lack of willpower, but I'm not sure it's capable of providing the same for true addiction.

[summerset 5,261]

@@ShelterDog64 Maybe that is the difference, I don't know. There is a lot of talk among the experts if food addiction is even real.

I personally think it is. There is a lot of evidence about dopamine pathways etc. and I think there is something addicting to certain foods and while eating too much or eating without appetite has a lot to do with the lack of efficient coping skills (still searching for something that's as powerful as food is, not giving up on that).

However, if it would be only the act of eating that serves as a coping skill, raw broccoli and celery would work as good as chocolate and chips (at least for me: nope, they don't).

[Stevehud 1,790]

@@Stevehud

BCBS doesn't have a waiting period. And since I am self employed I picked a plan that worked for me, not a plan that an employer picked that worked for them.

BCBS from what state bcbs of tx for example is 6 months of prior documented treatment.

or at least was almost 2 years ago

Edited November 21, 2016 by Stevehud

[Kumbaice 44]

Six month classes nutrition psch etc for Medicaid approval

Sent from my iPhone using the BariatricPal App

[OutsideMatchInside 10,166]

@@Stevehud

BCBS doesn't have a waiting period. And since I am self employed I picked a plan that worked for me, not a plan that an employer picked that worked for them.

BCBS from what state bcbs of tx for example is 6 months of prior documented treatment.

or at least was almost 2 years ago

BCBSIL

Also almost all insurance has changed, if you are super morbidly obese like I was, with a BMI of 60, there is no waiting period. Someone with that BMI is basically never going to lose weight on their own and insurance companies know it.

There was a cost benefit analysis in the insurance industry that showed the benefits of bariatric surgery to their bottom line.