IV. PREOP LIST OF QUESTIONS - Toni Sheets

        A Pre-Ops First Visit Question List
1.      Pre Surgery

        a.      What pre-testing do you require?  (Blood test, EKG, gall
                  stone ultrasound, upper GI, lung testing, chest
                  x-rays,
                  etc.)
        b.      What should I do to prepare for the surgery? (in
                general)
                  I have heard deep breathing helps, what does he
                 suggest?
        c.      Do I have to do anything special the day(s) before
               surgery?
                  For example, have a clear liquid diet or wash with
                   special
                  soap?
        d.      Do you require psychological testing?  Do I do it
               through
                  your office or on my own?
        e.      If I smoke, how will that effect the pre and post
                  surgery?
        f.      If I have asthma and/or sleep apnea, how will this
                  effect
                  the pre, during and post surgery?
        g.      I am allergic to ......., how will this effect my
                surgery?

2.      Surgery

        a.      Can you describe the surgery you perform?
        b.      How is the surgery performed?  Will you do it
                  laproscopily
                  or full cut.
        c.      How do you do the stomach?  I've heard of stapling,
                   sewing,
                  some staple and cut off the excess, some put bands,
                   and
                  others do  combinations.
        d.      Is the anesthesiologist experienced with big people?  We
                  have special  requirements due to the fact that fat
               cells
                  retain the sedative, and since we have more fat
                  cells...
        e.      How much of the intestines is by-passed?  Is it proximal
                   or
                  distal?   This has a lot to do with the side effects
                        that
                  can occur.
        f.      Do you cut the acid producing nerve to prevent ulcers?
                  Along those  lines, will you prescribe an acid reducer
                  after the surgery?  How long will I need to take it?
        g.      What do you do about the gall bladder?  (gall stones are
                  a
                  common  side effect - 30% of patients).  Will you go
                   ahead
                  and remove it (best  choice) or will he prescribe bile
                  salts to prevent them?  How long will I need to take
                 them?
        h.      Will you do a liver biopsy?  I've heard that this is a
                  common practice to show any irregularities.
        i.      Will I be in ICU?
        j.      How long will I be in recovery?
        k.      Will I get a morphine pump?  When will it come out?
        l.      Where will the IV be (neck or arm)?  When will it come
                  out?
        m.      Will you have a nasal tube or intubation tube?  When
                  will
                  it come out?
        n.      Will I have a catheter? When will it come out?
        o.      Will I have an epidural?  When will it come out?
        p.      Will I have a drainage tube in my incision? When will it
                  come out?
        q.      Will I have a drainage tube in my stomach?  When will it
                  come out?
        r.      Does he prescribe a stomach binder?  This will help a
                lot
                  with the  pain.
        s.      How soon does he allow water, juice, broth, etc. after
                 the
                  surgery?
        t.      Will he perform the operation or a resident?
        u.      Will you visit with my family in the waiting room after
              the
                  surgery to let them know how the surgery went?
        v.      I am concerned about telling my family.  This is a
                    private
                  choice for me, but I know they will want to be at the
                  hospital.  If I ask you to, will you assure them that
                   I am
                  doing OK but not tell them specifics about the
                   surgery?  I
                  do not want them to know that I have had obesity
                  surgery.
                  When I lose weight, I will tell them I am on a diet.



3.      Hospital Stay

        a.      Which hospital will you be using?  What is the
                       reputation
                  of the hospital?
        b.      Will I go into the hospital the day before or day of the
                  surgery.  If day of, do they have any "deals" with
                   local
                  hotels?
        c.      Can I pre-register at the hospital to save time?
        d.      How long is the hospital stay?
        e.      Are the gowns in the hospital for large people?  (Yes
                 they
                  are out  there.  I had one and I weighed over 450
               lbs.)
        f.      I have a lot of nasal congestions and use Afrin
                  regularly.
                  Can I still use it in the hospital?
        g.      I have heard of some people not having a bowel movement
                 for
                  several days after surgery.  Will I have to stay in
                  the
                  hospital until I do?  I have heard some people say
                  that
                  they had to stay and others who didn't.  What is your
                  policy?
        h.      Will I have a private room or will I share?
        i.      Can my husband/significant other/parent/friend stay with
                  me
                  at the hospital?
        j.      How often should I be walking?
        k.      Will I have lung therapy?
        l.      I have bracelets/rings that won't come off.  Will I need
                   to
                  have these cut off or can the hospital work around
                 them?
        m       What is the nurse/patient ratio?  For ICU and the
                    regular
                  floor I will be on.

4.      Complications

        a.      I have heard on one case where the surgeon went in and
                   due
                  to the size of the liver and blood analysis the
                surgery
                  could not be performed.  Have you ever had a case
                   where the
                  surgery had started and you  couldn't complete it? 
                  What
                  were the circumstances?
        b.      What  type of complications have you seen during surgery
                  and post-op?  (Ulcers, hernias, vitamin/mineral
                  nutritional
                  deficiencies,  iron deficiency, hair loss, gall
                  stones,
                  leaky staples, incision infection, blockage of the
                  connection between the stomach and the intestines,
                   etc.)
        c.      Have you had any patients die either in surgery, within
                     a
                  few days of surgery or later on because the surgery.
        d.      I have heard that it is harder to detect stomach cancer
                 and
                  ulcers after this surgery, especially in the "unused"
                  portion of the stomach.  Does you agree?  How
                concerned
                  should I be about this risk.
        e.      Will my hair fall out?  Does chewable zinc help?  When
                 will
                  it start falling out?  How much?  When will it grow
                 back?
        f.      I have heard that there is a lot of diarrhea and real
                  stinky gas after the surgery.  How can I minimize
                    these?  I
                  have heard Ginseng helps.  Are the diarrhea and gas
                  permanent or will it go away eventually?
        g.      Will I vomit a lot?  How will I know when to stop
                  eating?.
        h.      I am really concerned with my eating.  Can I "out eat"
                    this
                  surgery?
        i.      I understand that Wernicke-Korsakoff's syndrome is
                   caused
                  by a deficiency of vitamin B1.  How common is this and
                   how
                  can I prevent it?
        j.      I have heard of surgieries cancelled due to the H.Pylori
                  bacteria being present in your stomach.  What is this
                     and
                  can I do anything to prevent it?


5.      Miscellaneous

        a.      How long will the staples stay in?  (the outside
                staples,
                  the ones inside are permanent.)
        b.      I have to travel X miles by car/train/plane, should I
                take
                  any precautions?
        c.      How long will I have to be off work/school?
        d.      How long do I need someone to stay with me?  When can I
                  resume my normal household duties?
        e.      Do I have a limit on how much I can carry/lift?  For how
                  long?
        f.      What will the scar look like?
        g.      How much should I lose and how fast?
        h.      What will be my absorption rate after surgery?
        i.      How small will my stomach be?
        j.      Will it stretch back out?  After how long?
        k.      Will I have "dumping" after eating a lot of sugar?  How
                  painful is it?  How much sugar is a lot?
         l.       How much calories, nutrients, minerals, etc.
                  percentage
                  wise will my body absorb?  50%?  60-80%?

6.      After Surgery Care

        a.      What is your after surgery diet?  I've heard different
                  diets.  Some only clear liquids for 4 weeks, some
                  liquids 1
                  week, pureed for 4, then regular food adding one item
                  per
                  day.  What is your policy?
        b.      Are there any foods I need to stay away from?  (Nuts
                   peels,
                  etc.)  Can I never have these or is it just at first?
        c.      Does he have a live support group? And when do they
                  meet?
        d.      What are his follow-up requirements?
        e.      Do you require vitamin and protein supplements?
        f.      Will I need to get monthly B-12 shots?
        g.      Will I need to take the vitamins, supplements, B-12
                 shots
                  for the rest of my life?
        h.      How much water should I try to drink?
        i.      How often should I weigh?  Will I be subject to
                 plateaus?
        j.      What kind of exercise do you recommend after surgery and
                  how soon can I start?  What does you think about water
                  aerobics (this seems to be the exercise of choice for
                  most
                  of the people on my support e-mail group)
        k.      After the weight loss, are tummy tucks common?  Do you
                  perform those?  I have heard of surgeons at burn
                  centers
                  will perform the procedure free of charge except for
                   the
                  hospital stay to get the skin.  Have you ever heard of
                  this?



7.      Medical Conditions After Surgery

        a.      What about medications after surgery?  I take such and
                  such
                  and such.  Should I be OK with these?  Since my
                   absorption
                  rate will be #%, how will that effect my dosages? 
                  Should I
                  contact the prescribing doctor?
        b.      I have heard I will never be able to take aspirin or
                  anti-inflammatory drugs ever again.   What should I
                  take
                  instead?  Do you have a list of what I can and can not
                  take?
        c.      What about pregnancy after the surgery?  When can I have
                  children without risk to my unborn child or myself? 
                 Is it
                  considered a high-risk pregnancy?
        d.      I have heard that this surgery will really help my blood
                  pressure/diabetes/joint pain/etc.  How soon can I stop
                  taking my medicine for these?
        e.      I have heard of cases where when the person went to the
                   ER
                  and the doctors there put in a "tube" and punctured
                  the
                  stomach.  Should I get a medic-alert bracelet?
        f.      If worse comes to worse and I have severe nutritional
                  problems or if I am in accident with abdominal
                   injuries, is
                  this surgery reversible?
        g.      I have a lot of sinus drainage.  I have heard that this
                  will sometimes collect in the stomach and not "go
                  down".
                  What do you suggest to minimize this problem.

8.      About the Doctor

        a.      How many operations have you performed?
        b.      Have you performed the surgery on anyone my size?  Were
                  they successful?
        c.      Can I have some patient referrals?  If he/she says no
                 out
                  right, go to  another surgeon.
        d.      Do you have any malpractice suits?  I have checked my
                state
                  medical board  or consumer protection group and it
                  says.....I found this law suit, can you tell me about
                    it?
                  (Give the guy the benefit of the doubt if you find
                  anything, doctors are getting sued over everything)

9.      Insurance/Payment

        a.      How much will be the total cost of the surgery?
        b.      Have you  had anyone from my insurance group and if so,
                did
                  they have any trouble getting approval for the
                 surgery?
        c.      How often does insurance refuse to pay?
        d.      Will you help during the appeal phase, if my insurance
                  refuses the first request?
        e.      If my insurance won't pay do you and the hospital have a
                  flat cash rate (usually a lot less than the "with
                  insurance" price)?
        f.      My insurance will pay this much so that means I will
                have
                  to pay this much.  I can't afford to pay this much as
                a
                  lump sum.  Will you assign the benefits? (accept the
                  insurance amount as payment in full) or will you (or
                 the
                  hospital) allow me to make payments?
        g.      Does the hospital/surgeon except a sliding scale
                payment?
                  (income based, applicable to teaching hospitals
                mostly)
        h.      Do you or the hospital require a deposit?  How much?




        A PRE-OPS GET-READY LIST

1.      Groceries

        a.      Sugar free Carnation Instant Breakfast
        b.      Sustical, Ensure,  Boost, etc.
        c.      Water
        d.      Herb Tea (uncaffeinated)
        e.      fat free canned chicken or beef broth
        f.      Soup (stay with the simple ingredient ones)
        g.      creamed soups
        h.      bullion
        i.      rice or soy milk (nonfat) (only if lactose intolerant)
        j.      sugar free Jell-O
        k.      Mashed potatoes
        l.      Smooth, no sugar added yogurts
        m.      Gatorade
        n.      sugar free Kool-aid
        o.      fruit juices cut half with water  -- non pulp grape,
                apple,
                  Cranberry, etc.
        p.      applesauce
        q.      sugar free popsicles
        r.      Baby food
        s.      Hot cereal (oatmeal, rice, grits, etc.)
        t.      Baking potatoes

2.      Health Store

        a.      Designer Protein(similar to slim fast) or Challenge
                Amino
                  Acid Liquid Protein (Cherry).
        b.      Citrate of Magnesia (my surgeon makes you drink this the
                  day before surgery to "clean you out")
        c.      Liquid pain reliever
        d.      Liquid, Chewable, Spray or Powder Multi-Vitamin
        e.      Vitamin E Oil ( if you put it on your scar, it will heal
                  faster and not look as bad)
        f.      Zinc to prevent hair loss (common side effect)
        g.      Chewable Calcium (Tums)
        h.      Chewable or liquid Iron
        i.      Chewable or spray Ginseng to improve the smell of
                 passing
                  gas (common side effect)
        j.      Chewable, sublingual or liquid B-12

3.      Department Store

        a.      Dial (anti-bacterial soap)
        b.      ice cube trays for freezing right size portions of the
                  puree stuff
        c.      Blender  I think one of those hand held ones are
                wonderful
        d.      zip lock bags (to store frozen ice cubes)
        e.      shot glass for measuring
        f.      Play tea set (helps portion control)
        g.      camera (gotta have those before and after images)


4.      Beauty

Stuff for Minz Bath Oil
  Equal parts of these oils
        a.      Sesame (not roasted but cold pressed)
        b.      Olive (light)
        c.      Avocado
        d.      Almond
        e.      Vitamin E Oil
        f.      Vitamin A Oil (optional)
        g.      Fragrance (optional)

5.      Stuff for Hospital

        a.      toothbrush
        b.      toothpaste
        c.      deodorant
        d.      Lotion
        e.      Moisturizing lip gloss
        f.      powder
        g.      shampoo
        h.      brush
        i.      hair clips
        j.      gowns
        k.      robe
        l.      slippers
        m.      my comfy pillow
        n.      watch or travel clock
        o.      walkman
        p.      stuffed animal (hey it works for some people)
        q.      make up
        r.      writing paper
        s.      book(s), magazine(s), cross stitch, puzzles, etc.
        t.      Stomach Binder (if they don't provide it, check with
                your
                  surgeon.)
        u.      Comfortable clothes to go home in.

6.      After Hospital

        a.      Shower Chair (if you think you will need it)
        b.      A recliner (very few can sleep in a bed at first