Questions to Ask Your Surgeon Pre-Ops First Visit Question List Pre Surgery: 1. What pre-testing do you require? (Blood test, EKG, gall stone ultrasound, upper GI, lung testing, chest x-rays, echocardiogram [if you have taken fen-phen] etc.)  _____________________________________________________ _______________________________________________________________________________ _______________________________________________________________________________ 2. What should I do to prepare for the surgery? (in general) I have heard deep breathing helps, what does he suggest? ______________________________________________________ __________________________________________________________________ __________________________________________________________________ 3. Do I have to do anything special the day(s) before surgery? For example, have a clear liquid diet or wash with special soap? _________________________________________________________ __________________________________________________________________ 4. Do you require psychological testing? Do I do it through your office or on my own? _________ __________________________________________________________________ Hospital Stay 1. Will I go into the hospital the day before or day of the surgery?  If it's the day of surgery, do they have any "deals" with local hotels? __________________________________________ __________________________________________________________________ 2. Can I pre-register at the hospital to save time? __________________________________ 3. How long is the hospital stay? _____________________________________________ 4. Are the gowns in the hospital for large people? _________________________________________ 5. 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? _______________________________________ 6. I have heard some people say that they had to stay and others who didn't. What is your policy? _______________________________________________________________ 7. Will I have a private room or will I share? _____________________________________ 8. Can my parent stay with at the hospital?______________________________________________ 9. How often should I be walking?  ____________________________________________________ _______________________________________________________________________________ 10. Will I have lung therapy? __________________________________________________________ _______________________________________________________________________________ 11. What is the nurse/patient ratio? For ICU and the regular floor I will be on. ___________________ _______________________________________________________________________________ Complications 1. 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? _______________________________________________________________ _______________________________________________________________ 1. 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.) ______________________________________________________________________________________________________________________________________________________________   2. Have you had any patients die either in surgery, within a few days of surgery or later on because the  surgery. __________________________________________________________________ __________________________________________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________ 3. I have heard that it is harder to detect stomach cancer and ulcers after this surgery, especially in the "unused" portion of the stomach. Do you agree? How concerned should I be about this risk? __________________________________________________________________ 4. Will my hair fall out? Does chewable zinc help? When will it start falling out? How much? When will it grow back? _____________________________________________________ __________________________________________________________________ 5. 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? _____________________________________________________ _________________________________________________________________ 6. Will I vomit a lot? How will I know when to stop eating? ________________________________________________________________  ________________________________________________________________ 7. I am really concerned with my eating. Can I "out eat" this surgery? __________________________________________________________________ 8. I understand that Wernicke-Korsakoff's syndrome is caused by a deficiency of vitamin B12. How common is this and how can I prevent it? ____________________________________________________________________________________________________________________________________ 9. I have heard of surgeries canceled due to the H. Pylori bacteria being present in your stomach. What is this and can I do anything to prevent it? _________________________________  __________________________________________________________________ Medical Conditions After Surgery 1. What about medications after surgery? _______________________________________  __________________________________________________________________ 2. I take (fill in medication). Should I be OK with these?  ___________________________________ 3. Will this affect my absorption of my medication? _______________________ 4. 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 cannot take? _________________ __________________________________________________________________ 5. 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? ____________________________ __________________________________________________________________ 6. 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? ______________________ _________________________________________________________________ 7. If worse comes to worse and I have severe nutritional problems or if I am in accident with abdominal injuries, is this surgery reversible?  __________________________________ __________________________________________________________________ Surgery 1. Can you describe the surgery you perform? ____________________________________ 2. How is the surgery performed? ____________________________________________ 3. Will you do it laparoscopically or full cut? __________________________________ 4. 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. __________________________________ 5. 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... _________________________________________________________________ 6. How much of the intestines are by-passed? Is it proximal or distal? This has a lot to do with the side effects that can occur.  _____________________________________________ ________________________________________________________________ 7. Do you cut the acid producing nerve to prevent ulcers? __________________________________________________________________ 8. Along those lines, will you prescribe an acid reducer after the surgery? How long will I need to take it? ___________________________________________________________ 9. What do you do about the gall bladder? (Gallstones 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?    _______________________________ _____________________________________________________________ 10. Will you do a liver biopsy? I've heard that this is a common practice to show any irregularities.  ________________________________________________________________ 11. Will I be in ICU? _____________________________________________________ _________________________________________________________________ 12. How long will I be in recovery? ____________________________________________________ ______________________________________________________________________________ 13. Will I get a morphine pump? When will it come out? ______________________________ __________________________________________________________________ 14. Where will the IV be (neck or arm)? _________________________________________ 15. When will it come out? _________________________________________________ 16. Will you have a nasal tube or incubation tube? When will it come out? __________________ __________________________________________________________________ 17. Will I have a catheter? When will it come out? __________________________________ 18. Will I have an epidural? When will it come out? _________________________________ 19. Will I have a drainage tube in my incision? When will it come out? __________________________________________________________________ 20. Will I have a drainage tube in my stomach? When will it come out? __________________________________________________________________ 21. Does he prescribe a stomach binder? This will help a lot with the pain. __________________________________________________________________ 22. How soon does he allow water, juice, broth, etc., after  the surgery?  ____________________________________________________________________________________________________________________________________ 23. Will he perform the operation or a resident? __________________________________________________________________ 24. Will you visit with my family in the waiting room after the surgery to let them know how the surgery went? ________________________________________________________ Miscellaneous 1. How long will the staples stay in? (The outside staples, the ones inside are permanent.) _______ __________________________________________________________________ 2. I have to travel 2 hours by car, should I take any precautions? ________________________ __________________________________________________________________ 3. How long will I have to be off work/school? ___________________________________ __________________________________________________________________ 4. How long do I need someone to stay with me? When can I resume my normal household duties? _______________________________________________________________________________ 5. Do I have a limit on how much I can carry/lift? For how long? _______________________ __________________________________________________________________ 6. What will the scar look like? ______________________________________________ 7. How much should I lose and how fast? _______________________________________ __________________________________________________________________ 8. What will be my absorption rate after surgery? __________________________________ __________________________________________________________________ 9. How small will my stomach be? ___________________________________________ _________________________________________________________________ 10. Will it stretch back out? After how long? ______________________________________ __________________________________________________________________ 11. Will I have "dumping" after eating a lot of sugar? How painful is it? How much sugar is a lot? __________________________________________________________________ 12. How much calories, nutrients, minerals, etc., percentage wise will my body absorb? 50%? 60-80%?  ____________________________________________________________ _________________________________________________________________   After Surgery Care 1. 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? ____________________________________________________________ ____________________________________________________________________________________________________________________________________ 2. Are there any foods I need to stay away from? (Nuts peels, etc.) ______________________ _________________________________________________________________ 3. Can I never have these or is it just at first? _____________________________________ 4. Does he have a live support group? And when do they meet? ________________________ _________________________________________________________________ 5. What are his follow-up requirements? ________________________________________ __________________________________________________________________ 6. Do you require vitamin and protein supplements? ________________________________ __________________________________________________________________ 7. Will I need to get monthly B-12 shots? _______________________________________ 8. Will I need to take the vitamins, supplements; B-12 shots for the rest of my life? ___________ __________________________________________________________________ 9. How much water should I try to drink? _______________________________________ 10. How often should I weigh? Will I be subject to plateaus? ___________________________ __________________________________________________________________ 11. 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) __________________________________________________ ____________________________________________________________________________________________________________________________________ 12. After the weight loss, are tummy tucks common? _______________________________________ About the Doctor 1. How many operations have you performed? ____________________________________ __________________________________________________________________ 2. Have you performed the surgery on anyone my size? Were they successful? ______________ __________________________________________________________________ Insurance/Payment 1. How much will be the total cost of the surgery?  _________________________________ __________________________________________________________________ 2. Have you had anyone from my insurance group and if so, did they have any trouble getting approval for the surgery? ________________________________________________ __________________________________________________________________ 3. How often does insurance refuse to pay? ______________________________________ 4. Will you help during the appeal phase, if my insurance refuses the first request? ____________ __________________________________________________________________ 5. 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)? ________________________________________________ 6. My insurance will pay 70-80% so that means I will have to pay the rest . If 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?  _____________________  7. Do you or the hospital require a deposit? How much? _____________________________ _________________________________________________________________

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