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Monday, March 5, 2007

For those interested, a brief recap

Here is the process I have gone through to be approved for lap band surgery:
  1. December 2006: Attended an informational seminar by the Legacy Obesity Institute (Portland OR) which is a Center of Excellence for bariatric surgery. My insurance specifies that it will only cover surgery from a Center of Excellence. At the end of the seminar, which was about 45 minutes, you may receive a binder which includes an application to have surgery. You cannot get an application without going to (and listening to) a seminar.
  2. Completed and submitted an application to have surgery, which included some basic information about myself and my nutrition and exercise history. In addition, I submitted a typed history highlighting my particular reasons for wanting surgery.
  3. Early January 2007: Appointment with sleep medicine doctor, Poh Leng MD. He got my sleep history and recommended a sleep study, as he felt it was likely I had some sleep apnea.
  4. Mid-Janurary 2007: Scheduled and attended two consultation appointments at the Legacy Obesity Institute (LOI). These two visits entailed taking a psychological assessment (the Minnesota Multiphasic Personality Inventory, 264 questions) and a nutrition assessment, meeting with the nurse practitioner, dietician, psychiatrist and physical therapist, having a 12 lead EKG and a body composition analysis, and having a lot of blood drawn. The MMPI assesses whether or not you have some hidden psychiatric issues that might interfere with long term complience with instructions or ability to make decisions. The psychiatrist reviewed the MMPI with me and told me I was not psychotic. (yay!) The nurse practitioner did a physical assessment to get a sense of my general health and extent of comorbidities and obesity related health problelms that I might have. The nutritionist talked at length with me about what to expect nutrition-wise after surgery and what to do to prepare for surgery. The physical therapist discussed exercise post op and assessed my flexibility and ability to perform basic physical tasks. She declared me one of her fittest and most flexible patients. (Not that there is much competition for that title, I'm sure.)
  5. Early February: My paperwork was forwarded to the surgeon's office (Oregon Weight Loss Surgery, or OWLS). About 2 weeks later they called me to make an appointment to view an informational video about the band and see the surgeon. Although I wasn't sure yet if my insurance would cover the band, we tentatively planned for it pending insurance approval. I thought they would only cover gastric bypass, so up until this point was planning on having that surgery.
  6. I also had my first sleep study around this time. Although I barely slept and kept waking up every hour all night, it did show some mild sleep apnea according to Dr Leng. There is lots of info available online about how sleep studies go, so I won't go into much detail there.
  7. It took a little over 2 weeks to have my surgeon's dictation sent off to my insurance to get official approval. I was approved just last week and was able to schedule surgery almost immediately.

I'm lucky that this has all happened on a quick timeline. I thought about doing this for a long time, but once I decided I didn't want to wait around too much. I do think that the entire process is important to know where you stand from a complete physical standpoint, and to be sure that nothing is missed.

I also think the Centers of Excellence program is the key to the recent dramatic improvement in patient outcomes with bariatric surgery. After the horror stories from the late 90s and early 2000 until about 2005, something was needed to stop surgeons who made easy money off of desperate obese people willing to do anything. The requirements to become a Center of Excellence are strict and are almost entirely outcome based, that is, a surgeon or program has to be able to document and prove a long track record of short and long term positive outcomes to become a Center of Excellence. Usually these are hospital based practices that can do this, but some are free standing surgery centers.

Interestingly, everyone I met at the LOI and OWLS asked why I wasn't having surgery at OHSU, my employer, which is the other Center of Excellence in Portland. Well, I work in one of the ICUs there (the Trauma ICU). Every night the surgery schedule is printed and gone over so each ICU knows what cases to expect the next day post op. I would be on that schedule...so even if I managed to get through the OR and PACU and short stay unit without meeting anyone I knew, the chances are that everyone would still know what I was up to, and it's just not everyone's business. I had a hard time telling my FAMILY...I'm not going to announce my surgery to all of my coworkers and friends. The OHSU obesity clinic assured me that they would give me an alias and protect my privacy, but word spreads in hospitals, and I just felt better knowing my privacy was a little more secure in a hospital where I knew no one. Plus, OHSU doesn't do many Lap Bands, so it's better to be at a practice where half of their cases are bands.

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