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- How often are your seminars?
- I feel that weight loss surgery is the right choice
for me. What do I need to do to get started?
- How do I choose what operation is right for me?
- Do I need a referral from my primary care physician
to come see you?
- If I want to undergo weight loss surgery, how long
do I have to wait?
- Why does it take so long to get insurance approval?
- What can I do to help the process?
- What can I do before the initial consultation to
speed up the process of getting ready for surgery?
- How can an insurance company deny weight loss surgery
to treat a life-threatening disease?
- What impact do my medical problems have on the
decision for surgery, and how do the medical problems affect risk?
- Are there any medical conditions that would prevent
me from having surgery?
- What if I have had a previous weight loss surgical
procedure and I'm now having problems?
- How many total visits will I have at the office?
- Do you have an age or weight limit?
- Can weight loss surgery prolong my life?
- Can weight loss surgery help other physical conditions?
- How long do the operations last?
- When can I return to work?
- What are my activity restrictions after surgery?
- Will you perform laparoscopic surgery if I have
had a prior abdominal surgery?
- How much weight will I loose after my weight-loss
surgery?
- What are the routine tests required before surgery?
- Am I required to have any other test?
- What is the purpose of all these tests?
- Why do I have to have a GI Evaluation?
- Why do I need to have a Sleep Study?
- Why do I have to have a Psychiatric Evaluation?
- What is sleep apnea (SA)?
- What do I need to do to prepare for my operation?
- Will I be asked to stop smoking?
- If I continue to smoke, what happens?
- How often are your seminars?
We hold our free informational seminars at least twice a month.
Please click on the "Seminar Schedule" tab on the left to see
the dates of our upcoming seminars and location where they are
held.
- What do I need to do to get started?
The first step is to register for a free informational seminar.
Once you have learned about the benefits and the risks associated
with weight loss surgery you will be scheduled for your initial
consultation at our office. You will be able to schedule an appointment
at the end of our seminar.
- How do I choose what operation is right for
me?
Your attendance at the seminar will give you plenty of insight
into the weight loss surgery options. This information will help
you decide which operation is right for you. At your consultation
with Dr. Raja, he will help you finalize your decision.
- Do I need a referral from my primary care
physician to come see you?
If your health insurance is a PPO, POS etc., you do not need a
referral to seek a consultation with our surgeon. If you belong
to a HMO, you are required to obtain a letter of authorization
from your primary care physician prior to seeking a consultation
with Dr. Raja.
- If I want to undergo weight loss surgery,
how long do I have to wait?
The initial consultation is usually booked within a week of attending
one of our free informational seminars. Once you are seen, if
Dr. Raja and you agree it is appropriate, the operation can usually
be scheduled within 6-8 weeks.
- Why does it take so long to get insurance
approval?
After your initial evaluation is completed, it usually takes us
1-2 days to send a letter to your insurance carrier to start the
approval process. The time it takes to get an answer can vary
from about 3-4 weeks or longer. We have an insurance coordinator
who will follow up regularly on approval requests.
- What can I do to help the process?
Gather all the information (diet records, medical records, medical
tests) your insurance company may require. This reduces the likelihood
of a denial for failure to provide "necessary" information. Letters
from your personal physician and consultants attesting to the
"medical necessity" of treatment are particularly valuable. When
several physicians report the same findings, it may confirm a
medical necessity for surgery.
- What can I do before the initial consultation
to speed up the process of getting ready for surgery?
- Make a list of all the diets you have tried and bring it
to your initial consultation.
- Bring any pertinent medical data to your appointment with
Dr. Raja - this would include reports of special tests that
you may have completed recently (echocardiogram, sleep study,
etc.) or hospital discharge summary if you have been in the
hospital.
- Bring a list of your medications with dose and schedule.
- Stop smoking. Surgical patients who use tobacco products
are at a higher surgical risk.
- How can an insurance company deny weight
loss surgery to treat a life-threatening disease?
Authorization may be denied because there may be a specific exclusion
in your policy for obesity surgery or "treatment of obesity."
Such exclusions are difficult to overcome. Insurance approval
may also be denied for lack of "medical necessity." A therapy
is deemed to be medically necessary when it is needed to treat
a serious or life-threatening condition. In the case of morbid
obesity, alternative treatments - such as dieting, exercise, behavior
modification, and some medications - are considered to be available.
Medical necessity denials usually hinge on the insurance company's
request for some form of documentation, such as 1 to 5 years of
physician-supervised dieting or a psychiatric evaluation, illustrating
that you have tried unsuccessfully to lose weight by other methods.
- What impact do my medical problems have
on the decision for surgery, and how do the medical problems affect
risk?
Medical problems, such as serious heart or lung problems can increase
the risk of any surgery. On the other hand, if they are problems
that are related to the patient's weight, they also increase the
need for surgery. Severe medical problems may not dissuade you
from having weight loss surgery if it is otherwise appropriate,
but those conditions can make your risks higher than average.
- Are there any medical conditions that would
prevent me from having surgery?
Individuals who are able to have general anesthesia are able to
have weight loss surgery.
- What if I have had a previous weight loss
surgical procedure and I'm now having problems?
Contact your original surgeon - he or she is most familiar with
your medical history and can make recommendations based on knowledge
of your surgical procedure and body.
- How many total visits will I have at the
office?
After your attendance to our seminar you will have 2 visits at
the office before your operation; an initial consultation to gather
your health information and a pre-operative visit to review the
surgery and any ordered tests. After your operation, you will
be seen at 2 weeks, 3 months, 6 months, 12 months, 18 months,
24 months, and then on an annual basis for the first 5 years for
gastric bypass and sleeve gastrectomy patients. For the banding
patients visits are more frequent to evaluate the band and to
adjust it as needed.
- Do you have an age or weight limit?
- The adjustable gastric banding operation is currently restricted
to individuals who are 18 years or older by FDA guidelines.
Our minimal age for bypass and sleeve operation is 15 years
old. There is a concern that young patients may not have reached
full developmental or emotional maturity to make this type
of decision. It is important that young weight loss surgery
patients have a full understanding of the lifelong commitment
to the altered eating and lifestyle changes necessary for
success. We have set up special guidelines for patients younger
then 18 years old.
- Patients over 65 require very strong indications for surgery
and must also meet stringent Medicare criteria. The risk of
surgery in this age group is increased, and the benefits,
in terms of reduced risk of mortality, are reduced. We do
not have an upper age limit. Dr. Raja's oldest patient to
date has been 74 years old.
- Individuals must have a BMI of at least 35 to be considered
for weight loss surgery. We do not have a restriction for
maximum weight.
- Can Weight Loss Surgery prolong my life?
There is good evidence from scientific research that if you have
Type 2 diabetes, or other serious obesity-related health conditions,
are at least 100 lbs. over your ideal body weight, and are able
to comply with lifestyle changes (daily exercise and a healthy
diet), then weight loss surgery may significantly prolong your
life.
- Can weight loss surgery help other physical
conditions?
According to current research, weight loss surgery can improve
or resolve many associated health conditions, known as co-morbidities,
such as high blood pressure, diabetes, high cholesterol, sleep
apnea, etc.
- How long do the operations last?
Adjustable gastric banding operation takes about 30 minutes. Sleeve
gastrectomy takes about 60 minutes. Gastric bypass takes about
90 minutes.
- When can I return to work?
Individuals with banding operation may return to work in as soon
as 1 week. Our guidelines state that all of our patients should
be able to return to work in 2 weeks.
- What are my activity restrictions after
surgery?
You are able to get up and start walking just a few hours after
your operation. You may shower 48 hours after your operation.
You may be able to drive in about 7 days after your operation.
You can return to work in 2 weeks. You are restricted to lifting
no more then 20 pounds for the first month after your operation.
- Will you perform laparoscopic surgery if
I have had a prior abdominal surgery?
Yes. Dr. Raja performs all of the weight loss surgeries laparoscopically.
If you have had prior surgeries you may have a slightly increased
chance of your operation being converted to an open operation
because of excessive scarring, etc.
- How much weight will I loose after my weight-loss
surgery?
The actual weight a patient will lose after the procedure is dependent
on several factors. These include: the patient's age, weight before
surgery, overall condition of patient's health, surgical procedure,
ability to exercise, commitment to maintaining the diet and exercise
guidelines and other follow-up care, motivation of patient and
cooperation of their family, friends and associates. The medical
literature reports typical outcomes as percent of excess weight
loss. On the average, patients with adjustable gastric banding
will lose 50-55%, sleeve gastrectomy will lose 60-65% and gastric
bypass will lose 75-80% of their extra weight.
- What are the routine tests required before
surgery?
Certain basic blood tests are done prior to surgery: Complete
Metabolic Profile (CMP), Complete Blood Count (CBC), Urinalysis
(UA), PT/PTT, HgbA1c, Thyroid Stimulating Hormone (TSH), H.Pylori,
Cholesterol Profile and certain vitamin levels. All patients excluding
the very young get a chest X-ray, an electrocardiogram and a pulmonary
function tests. All patients are required to have a psychiatric
evaluation prior to their operation. Other tests, such as gallbladder
ultrasound, echocardiogram, sleep studies, GI evaluation, cardiology
evaluation, or, may be requested when indicated.
- Am I required to have any other test?
Work with your primary care physician to ensure that your routine
health exams are current. For example, women should have a pap
smear, breast exam, and if over 40 years of age, a mammogram.
For men and women over the age of 50 years, a colonoscopy is recommended.
If you do not have a primary care physician our office can refer
you to one on the day of your initial consultation.
- What is the purpose of all these tests?
An accurate assessment of your health is needed before surgery.
It is important to know if you have obstructive sleep apnea before
your operation since this can lead to sudden death post-operatively.
If you are diabetic, special steps must be taken to control your
blood sugar. Surgery increases cardiac stress therefore, your
heart will be thoroughly evaluated. These tests will determine
if you have a liver malfunction, breathing difficulties, excess
fluid in the tissues, abnormalities of the salts or minerals in
bodily fluids, or abnormal blood fat levels.
- Why do I have to have a GI Evaluation?
Patients who have significant gastrointestinal symptoms such as
upper abdominal pain, heartburn, belching sour fluid, etc., may
have underlying problems such as a hiatal hernia, gastroesophageal
reflux or a peptic ulcer. For example, many patients have symptoms
of reflux. Up to 15% of these patients may show early changes
in the lining of the esophagus, which could predispose them to
cancer of the esophagus. It is important to identify these changes
so a suitable surveillance or treatment program can be planned.
- Why do I need to have a Sleep Study?
The sleep study detects a tendency for abnormal stopping of breathing,
known as sleep apnea, usually associated with airway blockage
when the muscles relax during sleep. This condition is associated
with a high mortality rate. After surgery, you will be sedated
and will receive narcotics for pain, which further depress normal
breathing and reflexes. Airway blockage becomes more dangerous
at this time. It is important to have a clear picture of what
to expect and how to handle it.
- Why do I have to have a Psychiatric Evaluation?
The most common reason a psychiatric evaluation is ordered is
that your insurance company may require it. Most psychiatrists
will evaluate your understanding and knowledge of the risks and
complications associated with weight loss surgery and your ability
to follow the basic lifestyle changes. The psychiatric evaluation
may also help us identify if you suffer from emotional, behavioral
or eating disorders that may impact your after surgery care.
- What is sleep apnea (SA)?
It is the interruption of the normal sleep pattern associated
with repeated delays in breathing. Sleep apnea often shows rapid
improvement after weight loss surgery. In most patients, there
is a complete resolution of symptoms by 6 months following surgery.
- What do I need to do to prepare for my operation?
Preparation for the operation should began weeks before the operation
itself.
- You should begin your practice diet as discussed with you
at your initial consultation upon returning home.
- Dr. Raja also recommends initiating an exercise program
from that time on. This will prepare your heart and lungs
for the stress of the surgery.
- At least thirty days before your surgery date you should
stop smoking completely.
- Four weeks before surgery you should stop birth control
pills and hormone replacement medications.
- Two weeks before surgery you should stop aspirin and NSAID
products, 1 week before surgery stop taking Plavix, methotrexate,
and any herbal supplements you might be taking.
- One week prior to your operation should begin a liquid
protein diet, avoiding carbohydrates and fats. If you are
having gastric bypass or sleeve gastrectomy the night before
your operation you should complete your bowel preparation.
Remember, nothing to eat or drink after mid night the day
before your operation. Dr. Raja recommends Bariatric Advantage
nutritional products; you may click on the Vitamins and Nutritional
Supplement eStore button on the left of the screen and see
packaged items.
- Will I be asked to stop smoking?
Patients are required to stop smoking at least 1 month before
surgery.
- If I continue to smoke, what happens?
Smoking increases the risk of lung problems after surgery, can
reduce the rate of healing, increases the rates of infection,
increases the chances of deep venous thrombosis, and interferes
with blood supply to the healing tissues hence, increases the
possibility of leaks. In general smoking increases the possibility
of peri-surgery complications by 10 fold.
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