FYI: This is a LONG post! 

I had my 2nd Bariatric Consult with my surgeon on Monday October 18, 2010.  Very similar to my 1st Consult on August 9, 2010. 

I was called in by the nurse.  She weighed me (I lost 3 pounds), took me to the exam room, took my blood pressure, took my temperature, measured me (neck, waist and hips), asked the usual (do you have any pain, meds still the same, etc).  She then left and said the next person would be in shortly. 

The next one was the surgeon’s assistant, who I’m assuming is a doctor in training or something like that.  She asked me which surgery I had decided on.  I told her the VSG (sleeve).  She asked why and I told her because the LapBand was out from the beginning because I don’t want a foreign body in me, nor do I want a port under my skin that needs to be filled every so often… and the RNY (bypass) is more invasive, with intestines being cut and re-routed.  She agreed that it’s an excellent option for me.  She also checked my file and the computer to make sure all required items were there, like my requested medical records, my psych evaluation and my esophagram.  Everything was there, but she said I had not yet gone to cardiology for an echocardiogram.  I told her the dr. said there was no need because I had already had one when my primary care provider referred me for one at the end of March.  The results of that were normal and they should be in my medical records I had requested to be sent over.  She agreed, because I would have received a letter in the mail letting me know the echo had been approved (like with the esophagram they ordered).  I never received anything for an echo. 

She then asked if I had any questions in particular for the surgeon and I told her yes. 

1) I wanted to know what role my VSG would play in regards to gallbladder problems.  I currently do not have a gallbladder problem (ie: stones) but several family members have, and have had their gallbladder removed.  Most recently, my sister was diagnosed with gallstones that need to be surgically removed. 

2) I wanted to know if he would be able to do a SILS VSG (single incision laparoscopic sleeve gastrectomy).  In this case, he would make an incision in my belly button, rather than 5 or 6 across my stomach.  I wanted to ask him this because at the information seminar I attended in September, there was a patient of his who said this doctor had used this method on her.  This is appealing to me because a reduced number of incisions means less pain and reduced number of scars.

The next person to come in was the clinical/medical social worker (MSW).  She wanted to make sure I was in the process of getting regular therapy sessions with a psychologist.  I told her that I had first asked my son’s psychologist if he would see me.  He said no because he only sees children with ADHD, and even if he saw adults too, he would not see parent/children patients.  He recommended a couple therapists in that same office and told me to ask at the front desk for an appt with one.  I asked and was given the name of one, but was also told that I need to get auth from my insurance first.  I then was waiting for today to ask the MSW if it was ok or if I had to see one in particular.  She told me it’s ok as long as I see someone, anyone.  And she also said I do not have to wait to my next appt to ask her questions and gave me her card with phone numbers and email address.

The next person was the bariatric dietitian.  She went over with me all the lifestyle and dietary changes that I need to make for the surgery to be a success.  There were three main topics: 

1) The post-op diet progression from clear liquids to my new diet, to avoid pain, blockages and vomiting (dumping syndrome).

Stage 1:Clear Liquids (while in hospital only). 

Stage 2: Protein-based liquids (first 2 wks post-op). 

Stage 3: Pureed Food (weeks 3-4 post-op).

Stage 4: Soft food (weeks 5-6 post-op). 

Stage 5: New Diet (weeks 7+ post-op)

2) Then we went over the pre-op liquid diet I have to do for the 2 weeks before surgery.  This is a high protein liquid diet.  The purpose of it is to promote rapid weight loss and shrink the liver, making the surgery easier and safer.  The liver sits on top of the stomach, so it needs to be lifted up to gain access to the stomach during surgery.  The smaller it is, the safer and easier it is.

3) Lastly, we went over the vitamin and mineral supplements I need to start when I start my 2wk pre-op liquid diet.  She recommends Bariatric Advantage and gave me a brochure with their items and prices.  To start, they will include: Multivitamin, B12, Calcium, Vitamin D, and Iron.  This is because during the 2 wks pre-op and 2wks post-op, I won’t be taking in much nutrition.  It will be mostly liquids.  After that, they will be adjusted as needed.

The assistant came in again, this time with… my doctor!  He went over it all and answered the two questions I had.  He said as far as the gallbladder surgery, if I were to need it in the future, it would be no different than any other patient.  It would be a problem if  I were having RNY though.  He said he would take a look during my VSG surgery but didn’t feel any need to remove it anytime soon.  And regarding the SILS, he said it was possible and would try it, but if for any reason it wasn’t working for me, he would go to the multiple incision/trocar choice. He looked at my stomach (yes I had to pull my shirt up), felt it and said he could try it if I wanted him to.  I said yes!

I asked a question regarding insurance authorization and he said he’d go find out, but then another nurse came in and took me over to the scheduler’s desk.  She said they would submit my paperwork to the insurance and it would take from 1-2 weeks for them to approve it.  When approved, she would call me to schedule the surgery!!  With a surgery date, I am then to start the 2wk pre-op liquid diet.  I will have one more pre-op visit with my doctor (surgeon) a week before my surgery and then would see him again on surgery day! 

I am BEYOND excited… and sooooo ready for this to happen!!  🙂