To Sleeve (or not to sleeve) Series - #3, The Bariatric Surgery Clinic “Information Session” Experience

(This is part of a series I posted on my other (formerly anonymous) blog, tobypass.wordpress.com)

One of the first ‘official’ things one has to do in checking out the possibility of having bariatric surgery, is attending a lecture on the subject by a physician or surgery group.

Just a few weeks ago, I attended just such an information session. It was organized by a clinic out of Spokane, but which services a good chunk of the Eastern Washington region (Rockwood Bariatrics). I chose this group because it was recommended by my primary care physician (and also my father, who himself is a physician).

In talking with a few people I know personally who have undergone the procedure and related lifestyle change, it became clear that going through with it via a comprehensive clinic such as Rockwood in Spokane is the wisest choice. Rockwood Bariatrics (and others like it) provide psychological, dietary, group, and ongoing medical support before and after the procedure.  For this group, bariatric surgery is all they do — all day long — every day. They have a special OR dedicated to bariatric surgery, they have a special bariatric ICU and bariatric recovery units — all who do this work every day. Their entire work is dedicated to these few weight loss surgeries.

In my estimation — if I were to go forward with bariatric surgery, it’s a no brainer to do it with a clinic like this instead of a general surgeon who might be confident but certainly not as experienced — and completely absent the social supports.

Now — apparently, one does not simply walk into one of these specialist bariatric surgeon’s offices for a consult… In fact, the 3hour information session, beyond being informational and helpful, is a requirement to be seen. Period. (Luckily, it was free, and held in a nice hotel board room on the river.) But only after a person fills out paperwork, hands over insurance, and chit chats with the nurses, etc., is he/she blessed with a introductory consultation with a surgeon.

On one level, this seems like a lot of red tape before having a simple conversation. On the other hand, I don’t really blame the doctor for trying to weed out the field a bit. For certain people, a simple surgery to make it so you lose all your excess weight might be really tempting — a cheap, dirty and easy fix! The reality of what the surgeon explained in his lectures, is that an entire permanent lifestyle change is absolutely essential for long term change to take root. Without adequate education before and after, the surgery doesn’t have much of a prayer for success. My impression (an entirely subjective and probably prejudicial take) at the meeting I attended was that the majority of the attendees were in a lower/poor income class, poor education status, and poorly informed regarding basic matters of health. If my observation had any truth to it, it further justifies the reason for additional education ahead of time — as those who could be the most vulnerable might also be ones misguided into surgery.

The meeting was held in a hotel conference/ball room and there were perhaps 25 people present. Tables were set up with 2-3 chairs at each (and only on on one side) so attendees could point toward the front and take notes at the same time. Water was provided. It was nice. I could tell the group went to some expense to create this information session — [and clearly it is also a recruitment tool for their business].

In any case – this is what happened.

First – one of the doctors in the group (in this case Doctor Mathew Rawlins) got up front and gave a presentation for a little over an hour. He talked about obesity, obesity related illness, and surgery as the “only known long term successful treatment to the disease of obesity”.

[An aside — I found his description of the problem as a disease to be quite helpful and non-shaming. Kudos.]

Anyways, he had a powerpoint slideshow that documented the success rates of patients who have undertaken bariatric surgery, its history, and its safety. I’ll probably write more detailed posts about these options later but more or less, he outlined three different procedures that seem to be commonly done today (any one of which are referred to as ‘weight loss surgery’):

1. Gastric Bypass — the oldest procedure, originally developed to treat other medical problems back in the 50’s or 60’s; and with a well documented history of success for weight loss and associated comorbidities (albeit with some complications/downsides).
2. Gastric Banding – (pictured) — a newer procedure where a piece of hardware restricts food entering the stomach.
3. Gastric Sleeve or Gastrectomy – the newest procedure (Dr. Rawlins says he’s been doing it since 2007 and that it’s been around since maybe 2004?) – in which a significant portion of the stomach is actually removed.

For each of these, he outlined risks, complications, benefits, and documented outcomes. It became clear rather quickly that he does not at all favor gastric banding as a procedure because (according to his experience), people have a difficult time getting the right balance with it’s size. If the band is too tight, people can’t really eat and end up vomitting or having reflux. If it’s too loose, people don’t get much positive weight loss effects. To get it just right is difficult tedious. To make matters worse, so he said, sometimes the stomach can actually get pulled up through the ring and become necrotic…this apparently is an emergency  and must be fixed immediately. Anyways, he pretty much discouraged that one very thoroughly. I couldn’t help but think to myself that that one (while also less successful statistically in terms of weight loss) is also much cheaper and less invasive than the other two. Conflict of interest? Probably not. But I couldn’t help but think it.

Regardless, he spent a lot of time detailing exactly how the procedures for the other two were done and how they compare in terms of risk and outcome. His conclusion is that really, it comes down to personal preference and comfortability of the individual patient. He doesn’t think there’s much difference. They’re both good solid solutions.

Second – The clinic had a video of their dietician giving a lecture. This was less than impressive because it wasn’t a live person but what can you do? She talked about what the new diet would look like for a person who has gone through this surgery — she talked about what the workup and preparation looks like for a person who is getting ready for this surgery. Even though it was a video – it was crystal clear that if a total lifestyle change isn’t made, the surgery won’t work.
This isn’t a quick fix.

They aren’t just removing a bunch of fat and doing all the hard work that I didn’t want to do. (and of course, I’ve worked incredibly hard over the years managing my weight) — But this procedure is more like a ‘kick in the ass’ or a ‘boost’ on the road to recovery. And for most people, it works. They get to where they want to be. And it costs them something.

I’ll write more about what a post-surgery diet might look like but suffice it to say — it appears quite a bit different from how I’ve been living and eating — which is largely by guestimation and desire. A great deal of care will need to go into ensuring proper nutrition, proper balance, enough protein, the right foods. They said that the volume in a sitting will be reduced to about 1/2cup — and that about 6x per day. Because volume will be so much smaller, what a bariatric surgery patient does eat must be packed with quality. He/she could fill up on a 1/2cup of mashed potatoes but that isn’t very nutrient rich. This will take planning and care. Which my diet has little of now.

And this realization is kind of dawning on me in general — in order for me to achieve a healthy weight, I’m going to have to pay attention to what I eat. There’s no getting around it. I’ve sleepwalked through my diet for my whole life — simply eating out of emotion and desire. And this is where it’s got me. I can’t imagine that I will be able to go back to a place where I’m totally unconscious. One way or another, I will need to pay attention. I need to learn how. This is whether I have surgery or not.

Anyways, the third, thing that happened was a short discussion about insurance and next steps. Apparently this clinic has case managers that lead patients through the entire process — and it’s quite a process!!

It begins with an examination of insurance coverage (mine covers it as far as my conversations with my company) psychological evaluation, doctor consult, dietician meetings, lab tests and any other required testing, a pre-op diet to shrink the liver (this is both required and essential apparently), and the list goes on and on and on. As I alluded, this clinic also has quite an extensive post-operative system of group meetings and support that conceivably goes on for the rest of life.

SO where I’m at in the process right now is waiting to talk with a case manager about exploring it further…As well as waiting to speak once again with my primary care doc about what I’ve discovered since we last met.