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Initial consult: Detailed questions, topics discussed and first steps



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Posted (edited)

For my visit, I talked on the phone to a nurse and after met virtually with the physician's assistant and dietitian. I can post about my dietitian's visit later if anyone is interested.

First, I spoke with the nurse over the phone for about 15 minutes. She asked the following questions:

  • What type of surgery or intervention are you interested in?
  • What is your current weight?
  • What is your blood pressure?
  • Tell me about any prior surgeries?

Next, I met with the physicians assistant (PA-C), for about 50 minutes. She asked the following questions:

  • What is your weight history?
  • How long have you struggled with weight?
  • What do you think is the cause of weight gain?
  • What are your lifestyle habits?
  • Have you taken weight loss medication?
  • Did the weight loss medication work for you?
  • How much weight have you gained in the last year?
  • What is motivating you to lose weight?
  • What type of exercise are you doing?
  • What's your living situation like?
  • Do you eat out?
  • Who does the cooking in the household?
  • Do you eat three meals a day?
  • Do you snack?
  • What are you snacking on?
  • Do you struggle with emotional eating?
  • Have you been diagnosed with a kidney stone?
  • Do you have an irregular heart rhythm?
  • Have you had an EKG?
  • Any bleeding disorders or blood clots?
  • Have you been diagnosed with an eating disorder?
  • Have you met with a therapist?
  • Do you have heartburn?
  • Do you have a stomach ulcer?
  • Do you use your CPAP?
  • Multiple family planning questions.

Next, we discussed my medical history. She gave a general overview of:

  • Obesity
  • Metabolic processes
  • Emotional health
  • Coping skills
  • Lifestyle changes
  • Weight loss medications
  • Expectations

The differences in surgery, benefits, and risks associated with the sleeve and RNY were discussed. She made a surgical recommendation. There is a 2-form of contraception requirement. I was given an outline of tasks to complete. Those were: scheduling a blood draw and contacting my sleep center to request my CPAP usage download. A scheduler will call to schedule a psychological assessment, physical therapy, and an appointment with the nurse clinician who'll act as my contact throughout the process. It was also encouraged that I attend the support group for bariatric and weight management patients.

Lastly, I was given the clinic's late policy and the reminder that if I gain 10 pounds before surgery, I will be re-evaluated to be sure I'm a good surgical candidate.

I had the blood draw and eight tubes were taken. I was tested for Vitamin deficiencies including B1, B6, D. Also, Calcium, Iron, prediabetes, cholesterol, creatinine for kidney function, parathyroid hormone, and others.

Hope this helps anyone curious about the first visit.

Edited by DoodlesMom

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I had a somewhat similar experience, except I have not had any visits in person due to COVID - everything has been on zoom.

The NP visit was a group visit and they just talked about the program and surgery in general and obesity information.

I met with the surgeon who took a general medical/surgical history and asked about what surgery I was considering, but told me his recommendation was for a different surgery (I am in agreement with him).

I met with the nutritionist who asked me about history of disordered eating, what I eat, if I had any things I couldn't/wouldn't eat, binging, meal skipping, night eating, use of medications for weight loss, previous weight loss attempts, etc.

I met with the psychologist who took a psychological history (this was long because I have bipolar disorder and anxiety) and asked about eating disorder behaviors in detail (like restricted eating, purging, over exercising, etc). She talked about my concerns about the surgery and support systems and my expectations.

I was told my insurance required 4 monthly group nutrition classes. I have gone to the first one and the second is this week. The first one was so dumb. It just covered general nutrition, what is a calorie, healthy eating, carbs, fats, etc but it doesn't talk about how to eat after surgery. Like they were showing portions that are way too big for post surgery.

I tried to ask the weight center team about what tests I will need and they keep saying I won't need any (endoscopy, sleep tests, ECG, chest X-ray etc). I was surprised, but I don't have many co-morbidities other than high LDL cholesterol and mental health issues and Migraines. I may or may not have GERD; there is some disagreement about that. I have some symptoms but not the standard ones.

Oh, I called the surgery center the end of January and I'm told I might be able to have surgery in August!!!! This is partly insurance hoops to jump through but also COVID delays as surgeries were stopped a lot last year and also Dec-Apr this year.

I hope the info @DoodlesMom and I provided is helpful for someone thinking about surgery and curious about the process.

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22 hours ago, lizonaplane said:

I had a somewhat similar experience, except I have not had any visits in person due to COVID - everything has been on zoom.

The NP visit was a group visit and they just talked about the program and surgery in general and obesity information.

I met with the surgeon who took a general medical/surgical history and asked about what surgery I was considering, but told me his recommendation was for a different surgery (I am in agreement with him).

I met with the nutritionist who asked me about history of disordered eating, what I eat, if I had any things I couldn't/wouldn't eat, binging, meal skipping, night eating, use of medications for weight loss, previous weight loss attempts, etc.

I met with the psychologist who took a psychological history (this was long because I have bipolar disorder and anxiety) and asked about eating disorder behaviors in detail (like restricted eating, purging, over exercising, etc). She talked about my concerns about the surgery and support systems and my expectations.

I was told my insurance required 4 monthly group nutrition classes. I have gone to the first one and the second is this week. The first one was so dumb. It just covered general nutrition, what is a calorie, healthy eating, carbs, fats, etc but it doesn't talk about how to eat after surgery. Like they were showing portions that are way too big for post surgery.

I tried to ask the weight center team about what tests I will need and they keep saying I won't need any (endoscopy, sleep tests, ECG, chest X-ray etc). I was surprised, but I don't have many co-morbidities other than high LDL cholesterol and mental health issues and Migraines. I may or may not have GERD; there is some disagreement about that. I have some symptoms but not the standard ones.

Oh, I called the surgery center the end of January and I'm told I might be able to have surgery in August!!!! This is partly insurance hoops to jump through but also COVID delays as surgeries were stopped a lot last year and also Dec-Apr this year.

I hope the info @DoodlesMom and I provided is helpful for someone thinking about surgery and curious about the process.

I had to have blood work, a GI study and an ultrasound done. Then a month before surgery, I had to have blood work again and an EKG. It is crazy how different each surgeon or center is on what has to be done. I also had to do 4 life skills classes and a post op class.

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8 minutes ago, FadingIrish said:

I had to have blood work, a GI study and an ultrasound done. Then a month before surgery, I had to have blood work again and an EKG. It is crazy how different each surgeon or center is on what has to be done. I also had to do 4 life skills classes and a post op class.

There might be stuff that I will have to do right before surgery they said but I won't know until I get initiated into the secret society... Or whatever

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Just now, lizonaplane said:

There might be stuff that I will have to do right before surgery they said but I won't know until I get initiated into the secret society... Or whatever

My surgery is next week, but I feel like due to COVID, things went very slow for a bit, surgeries were postponed and now they are rushing thru pre op stuff because another shut down is looming. So my first tests were 3 months before surgery, and then 1 month before. I started the process in December, and surgery in April. So it was pretty quick. Secret society. Lmao.

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6 minutes ago, lizonaplane said:

There might be stuff that I will have to do right before surgery they said but I won't know until I get initiated into the secret society... Or whatever

It varies significantly what is required. I had one meeting with dietician and a psychiatrist and that was it.

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On 4/13/2021 at 10:13 AM, lizonaplane said:

I had a somewhat similar experience, except I have not had any visits in person due to COVID - everything has been on zoom.

The NP visit was a group visit and they just talked about the program and surgery in general and obesity information.

I met with the surgeon who took a general medical/surgical history and asked about what surgery I was considering, but told me his recommendation was for a different surgery (I am in agreement with him).

I met with the nutritionist who asked me about history of disordered eating, what I eat, if I had any things I couldn't/wouldn't eat, binging, meal skipping, night eating, use of medications for weight loss, previous weight loss attempts, etc.

I met with the psychologist who took a psychological history (this was long because I have bipolar disorder and anxiety) and asked about eating disorder behaviors in detail (like restricted eating, purging, over exercising, etc). She talked about my concerns about the surgery and support systems and my expectations.

I was told my insurance required 4 monthly group nutrition classes. I have gone to the first one and the second is this week. The first one was so dumb. It just covered general nutrition, what is a calorie, healthy eating, carbs, fats, etc but it doesn't talk about how to eat after surgery. Like they were showing portions that are way too big for post surgery.

I tried to ask the weight center team about what tests I will need and they keep saying I won't need any (endoscopy, sleep tests, ECG, chest X-ray etc). I was surprised, but I don't have many co-morbidities other than high LDL cholesterol and mental health issues and Migraines. I may or may not have GERD; there is some disagreement about that. I have some symptoms but not the standard ones.

Oh, I called the surgery center the end of January and I'm told I might be able to have surgery in August!!!! This is partly insurance hoops to jump through but also COVID delays as surgeries were stopped a lot last year and also Dec-Apr this year.

I hope the info @DoodlesMom and I provided is helpful for someone thinking about surgery and curious about the process.

Thanks for being so open. I learned a lot from your post. I'm the type of person who wants to know the specifics of every part of the process. It's so interesting to me to hear different experiences. Knowing lets me prepare and puts my mind at ease. Something that stands out is everyone's course is dependant on medical history, current disease, insurance, and your team's methods to get you to your goal.

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On 4/14/2021 at 9:16 AM, FadingIrish said:

My surgery is next week, but I feel like due to COVID, things went very slow for a bit, surgeries were postponed and now they are rushing thru pre op stuff because another shut down is looming. So my first tests were 3 months before surgery, and then 1 month before. I started the process in December, and surgery in April. So it was pretty quick. Secret society. Lmao.

Good luck with your surgery!

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I haven’t heard about the 2 form of contraceptive requirement! Maybe my surgeon knows I don’t get any action 😹

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5 hours ago, LuckyKelleyK said:

I haven’t heard about the 2 form of contraceptive requirement! Maybe my surgeon knows I don’t get any action 😹

Ha! I'm not either.😃 She said the IUD is both hormonal and structural so it counts as the 2 forms. Another 2 form would be the pill with a condom or spermicidal lubricant. She said some choose more permanent methods like vasectomy or get tubes tied at the time of weight loss surgery. Depending on which way you go, it could be either not a big deal or a major decision. I'm not sure what I'll do yet.

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15 hours ago, LuckyKelleyK said:

I haven’t heard about the 2 form of contraceptive requirement! Maybe my surgeon knows I don’t get any action 😹

I haven't, but they haven't told me anything about what I can and cannot do around surgery. I haven't had sex in several years, so not an issue for me.

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15 minutes ago, lizonaplane said:

I haven't, but they haven't told me anything about what I can and cannot do around surgery. I haven't had sex in several years, so not an issue for me.

I understand why, though. I worked on a bariatric surgery floor for 6 years (and still float there sometimes) and I have seen at least one instance of someone coming in on surgery day and having to have it cancelled because of a positive pregnancy test 😩

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19 minutes ago, LuckyKelleyK said:

I understand why, though. I worked on a bariatric surgery floor for 6 years (and still float there sometimes) and I have seen at least one instance of someone coming in on surgery day and having to have it cancelled because of a positive pregnancy test 😩

Yikes! I'll keep that in mind.

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