Weight Loss Surgery: The Preop Phase

One of the aspects of this experience that I really appreciate was how thorough the bariatric surgery preop approval process was. It made me feel confident that it wasn’t just about the $ for my surgeon. Even more importantly, it showed me that I could see this through. The number of appointments and evaluations I had to get through in the midst of school, work and clinical, was a little bit nuts. But I did it.

Did I bitch and moan along the way? Perhaps a little. ­čśë

Of course, part of the reason this experience was so detailed is because insurance requires it. Since this is considered an elective procedure, there are a lot of hoops to jump through to demonstrate you’re not too unhealthy to have the surgery in the first place (ironic, no?). But regardless, I feel much better about going into fairly major surgery knowing that we have prevented potential complications as much as we can.

Here is a run-down of my preop life, in calendar view:

  1. December 18, 2014: Attend an information seminar led by my practice’s case manager and one of the surgeons (the surgeon I ultimately chose to do my procedure). Learn about insurance requirements and the different types of surgery available. S comes with me and tells me he will support whatever decision I make. What a guy.
  2. January 21, 2015: Initial consult with the surgeon to talk about my options. We’re weighing SIPS versus sleeve gastrectomy. While I’m there, have labs drawn and get an ECG and chest x-ray done at the neighboring hospital. Also meet with the case manager to discuss the entire process, step-by-step.
  3. January 29, 2015: Tell my family that I’m planning to undergo weight loss surgery. Get nothing but love in return. I am a lucky lady.
  4. February 4, 2015: Seven-day food diary review with the physician assistant in the office. We discuss some of the changes she recommends I make now. Also find out during this visit that I had an abnormal ECG, which means I’ll have to get a cardiologist to clear me before I can be approved. Rats.
  5. February 12, 2015: Evaluations with the in-house nutritionist to talk about the pre-op and post-op diet requirements, and with a psychologist to make sure I can cope with the lifestyles changes I’m going to face. Also fill out two psych tests to make sure I’m not (too) crazy. ­čśë Accomplish both evaluations in one day. Fun.
  6. February 18, 2015: Initial evaluation with cardiologist. He thinks the ECG was probably due to “low voltage given [my] body habitus”. In other words, I was too large to get a good signal. But just to be safe, we schedule a stress test and echo for later this month. This is also supposed to be the night I have my sleep study, but then it starts to snow and all of North Carolina goes into lockdown mode. Sleep study is rescheduled.
  7. March 4, 2015: Long-awaited sleep study to determine if I have obstructive sleep apnea (OSA). I’d been diagnosed with mild OSA years before but never got a CPAP because insurance wouldn’t cover it at the time. I have a feeling it’s worse these days.
  8. March 12, 2015: Undergo EGD (aka esophagogastroduodenoscopy…say that five times fast) with my surgeon. Nothing too scary ┬áin there. I’m cleared for surgery from a GI standpoint.
  9. March 13, 2015: All required testing for insurance purposes is done. Case manager submits me to insurance for pre-approval and tells me it will take about 14 business days.
  10. March 17, 2015: Stress test and echo. Cardiologist says everything looks good, except for my markedly reduced exercise capacity for a woman my age. No sh*t. But I get my cardiac clearance.
  11. March 18, 2015: Sleep study #2. Sleep apnea was confirmed (much more severe this time around), so now I come back to be fitted for a CPAP and figure out what settings I will need at home. Find out I have to meet with the sleep center medical director (who also happens to be my surgeon) to review the results before I can be scheduled for surgery. He is booked for two weeks. Start to panic that I won’t be able to schedule surgery┬áduring the very narrow window I have in between semesters to get through it and start to recover. Want to cry. Sleep center manager sees my distress and fights for me to get an appointment by the weekend.
  12. March 19, 2015: Receive notification that insurance has approved my surgery! What a relief!
  13. March 21, 2015: Early Saturday appointment with sleep center director/surgeon to review my sleep study results. He knows I’m pressed for time as well and his medical assistant flips my visit to a results review – to go over all of my diagnostic testing at once. It’s the last step before I can be scheduled. I love these people. Before I leave he checks his calendar and gives me a date: April 23. I could kiss him.
  14. March 23, 2015: Get a phone call from the surgery scheduler that I am officially on the books for 4/23. They email me preop instructions and we pick a date for my pre-op appointment with anesthesia. One month to go.

I’m exhausted just re-creating this list! Let’s just say I’ve already met my out-of-pocket maximum for the year, and I haven’t even had the surgery yet. Lots of ups and downs over the past few months, but when all is said and done I’m glad they were so thorough.

Next up: the dreaded pre-op “liver diet”. It’s only temporary, right?

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