AliPat

Kaiser ( S. Sac) 2017-18 Process. step by step

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At the beginning of my journey, I couldn't find much info about Kaisers Bariatric process.  So I documented every step along the way as best I could, that way I could post it here when I was done.

FYI, this is for the South Sacramento Kaiser ONLY.  I have NO idea if it is different at any other Kaiser location.   Also, I am a government employee and my coverage is pretty good.  $10 co-pays for Dr visits, classes were free, and...as far as I know, I do not have a co-pay for surgery.   Also, if I am to understand correctly, they change the "process" semi-regularly, so I do not know how long this will be 'valid".

Warning, this is a copy and paste from my blog, there may be an offensive word or two in here.  I tried to proof read to delete them from here, so If I missed any, please PM me with the location of said word, so that I can edit it out.

Here it is....

WARNING: Kaiser is not playing around when they talk about enforcing compliance of the program requirements or rules.

Just to make clear, I am not affiliated in any way with Kaiser other than being a patient myself.  These are my personal experiences with Kaiser.

✔ Step One: 8/4/17  - Made the decision to have surgery  -  Spoke with PCP and she agreed, without hesitation, to give me a referral after I completed the Weight Loss Surgery Overview Class. I called the same day to sign up for the class and the next available class was almost 2 months out and the only one on the schedule.  Of course I added myself to the list.  Honestly, I am glad it was not any sooner.  I have yo-yo'd on my desire/decision to have surgery, as I have brief intermittent moments of divine intervention.  In those moments, am absolutely certain I can lose weight without surgery.  Then I come across some experience or tid-bit of info that reminds me that I need help to lose weight.  Like stepping on the scale this morning to see that I have gained 2 more pounds.

✔ Step Two 9/28/17 - Weight Loss Surgery Overview "Health Education"  -  At the class we were told that it is the last mandatory pre-req class being required/offered as part of the process.  From here on out, others will not be required to complete this step (according to the person conducting the class)

This was a lightweight overview of things that will be needed,  on a personal level, to succeed with weight loss (with or without surgery)  Topics included, 1) types of surgery offered at Kaiser, 2) Lifestyle changes, 3) mindfulness, 4) Readiness and goal setting.

✔ Step Three  10/2/17  -  Referral from PCP to Bariatric Surgeon  -  My Doctor was super fast with this one.  I emailed her as I was leaving the parking lot of the class to let her know that I had completed and was seeking a referral.  I got an automated reply that she was on vacation for another day.  I went ahead and scheduled an appointment with her for the following friday, just in case.  By Monday 10/2 she had replied that she sent the referral and they would contact me to schedule the next appointment.  As soon as I was done reading her email, I was getting a call from the bariatric center to schedule the appointment.   The next available was 10-19 (three weeks out)  and they are only held on thursday mornings at 8am.  I knew I would be teaching that week and asked if there was any way to get into one of the next 2 classes, and she was able to squeeze me in for this thursday!!

✔ Step Four 10/4/17  -  4hr Orientation with Bariatric Team  -  First of 8 "steps".  I left there feeling hopeful.... and scared shitless!  It was a very detailed and thorough class.  Definitely the "come to Jesus... try to scare you out of surgery" class I expected it to be.

The above video states the process if you would rather watch than read, but there are far more details below.

     However, I didn't know that you would have to be 3months clean from drugs (legal recreational drugs too) You have to have quit smoking cigarettes and medical marijuana (including second hand smoke), prescription pain and prescription diet meds for 3mo.  But here's the kicker....this includes vaping with nicotine or THC and edibles. Wish I would have known that 2 months ago when I called for a referral to WLS.  I could have been working on getting clean and been 2mos in by this point.  They stated they would be drug testing randomly.

    However, truth be told, I first tried to quit smoking cigarettes back in January.  It took me over 8 months to give them up entirely using a vape with nicotine.  My last cigarette was smoked 9-24-17 at 8am.  It was the only cigarette I had and the only one I smoked that day. That makes 13 days (as of me writing this part)   So the reality is that even if I knew 2 mos ago, the struggle probably would have been just as real.  But, I definitely could have stopped with the THC vaping and edibles I take at night before bed.  I have options as far as substituting pain relief and sleep aids.  No  options for nicotine other than cold turkey!  Worst case scenario, I will have surgery in 3 months instead of 6-8 weeks.

     I left the orientation with an appt with the surgeon on 10-9-17.  I got lucky with that one.  Other people in the class left with an appt almost a month out.  Not sure how they (or even IF they) have a method for scheduling priority.

     I also received a very large note/work/school book.  We are to take it to all classes and meetings.  We are also to start logging ALL food eaten.  Either by hand or in an Ap.  I chose "my fitness pal" and it is working good for me.  You can also download and print the logs from the ap.

     At the orientation we left with a diet plan.  1200 Cal/day High protien, low carb-ish.  This is "good to know" info, as you can start doing it now and save some time after the orientation by having a little weight loss under your belt before you get there, IF you have already had your highest weight recorded with kaiser.   If not, and you are barely eligible for surgery based on being at or near BMI 40, it's best to wait and get weighed in at the orientation.  Or, if you want to start losing weight ASAP, go get yourself weighed in at any nurse station in a Kaiser facility and make sure you see it in your med record under "past visits".  Then you can start losing weight while you wait for orientation.

     Speaking of weight loss... how much do you have to lose before surgery?  Glad you asked.

5-10% of your highest overall weight recorded at Kaiser.  So, If you are at your highest weight now, and you have never had THIS weight recorded by the Dr. .... Get in there NOW and have a weight check and make sure they RECORD it in your patient file.  Then you can start losing weight before the orientation if you want.  They said they will count any weight loss prior to orientation, from your HIGHEST recorded weight.

     After orientation, you will get your pre-surgery goal weight at your first eval with the surgeon.  Once you have reached your goal weight, you can meet with the Nurse Manager to schedule surgery.  You must then MAINTAIN that goal weight (ok to lose more) until you have surgery.  Also, they said you will NOT be disapproved if you go below the required BMI of 35-40 during this phase.

 

Note - They were very clear, that from this point in the process and forward, the following steps are required from everyone, though not necessarily in the exact same order I have listed below. This is the order of MY steps.

Some patients will need a couple extra steps maybe with psych, dietitian, or specialist based on co-morbidities and any struggles you may be having.



✔  Step Five 10/9/17  -  Eval with Surgeon - Get pre-op goal weight  -  This was a great appointment for me.  I already lost 5 lbs..... yeah!  And I only need to lose "at least" 7 more pounds in order to have surgery, I will explain this below.

 

Three things to inform/update you on.

1) Pre-op weight loss requirements: Evidently their general rule of thumb is to only give you a "range" of weight loss needed.  Minimum loss needed 5%, though they would like you to lose 10%.

That is the understanding I got at the appointment.  Though it could be different for some people.  They said they do understand that it is not possible for some people to lose  the full 10% and they don't want to NOT approve someone because they can't get all the way to 10%.  So my minimum weight loss goal weight is 217 lbs, but if I could get down to 207 lbs, that would decrease my risk of complications (which are minimal anyways)

2) Drug testing: They REALLY do test you... however, not immediately, if they don't suspect anything.  My understanding is that you get tested when they do the pre-op blood work.  If that is negative, obviously you are good to go.  BUT, if it is positive...then you will need to get clean, have a negative test result, then they will make you wait 3 months from that negative test before you can have surgery. And obviously still test negative along the way.  I confirmed that they test for Nicotine and Cannabis. As well as the other standard non-legal drugs. So, as most cannabis users know, you need about 30 dys sober before you can test negative for cannabis, and there is no way to cheat a blood test (that I know of)  But, I had never heard of nicotine testing before yesterday, even though I smoked for over 30ys.  So, I'm headed to the Vape Shop to get 0mg nicotine.  It's already been a week since my last bit of THC.  I should be good for testing in 30dys!  BEWARE:  This was scheduled when I met my goal weight and I called to schedule the next step, and it had to be completed within 3 days or would be considered a positive test for drugs.  **UPDATE**  A friend of mine was drug tested sooner in the process than I was.  She failed her nicotine test.  I haven't been able to determine what may have prompted sooner testing, as we were interrupted while I was talking to her about it.  If I figure it out, I will update this section. 

3) Type of surgery chosen:  Your desires and wishes are taken into account, however, if your medical history or biological makeup prohibit one surgery, they will recommend the other one.  I wanted the sleeve and luckily there is nothing preventing me from getting it.  I was approved for the Gastric sleeve.  They only offer the Gastric sleeve and the Rou-en Y bypass.   They no longer do the lap-band as there were too many complications and they are more than happy to remove one for you. They also do not do the Duodenal Switch or any other new types like balloons etc.


✔ Step Six 10/12/17  -  Attend minimum of 1 Kaiser sponsored WLS support group meeting ( Can be at your local Kaiser, if offered: Only held on 2nd Thurs of every month for Stockton)

I actually really enjoyed the support group in Stockton.  I had been struggling with other peoples opinions, judgments and comments about my decision to have weight loss surgery.  The group helped me to be strong and ignore everyone else.  Being a person who is the teacher, helper, facilitator... it's hard for me to put myself first and to ask for help.  It was nice to be in a room full of people who "get" what I'm going through without me having to explain myself.  Thanks! BEWARE: write down the name of the support group facilitator.  Take a picture of it so you will have this info in your phone if needed.  Even though I attended both the 10/12 and 11/9 meetings, on 11/29 the bariatric center almost wouldn't let me continue in the process because they had NO proof of this on file.  We were assured at the meeting that our attendance would be transmitted within 24hrs, Evidently that may not actually happen. 

 

✔ Step Seven 10/19/17  - Nutrition class 2hr - Not much to tell here.  If you went to the orientation, this is just a  slightly more detailed repeat, about food requirements before and after surgery.  Despite what they said at orientation about being rescheduled if you don't bring your handbook to this appointment, they had loaners there and .turned no one away.  They also did not ask for my 2 week food log that they said we would need to provide. I guess it's better to  be over prepared than under prepared.  But they said, now that you have been "taught" how to eat and keep a log, you must bring 2 weeks of food logs to all future appointments.  


NOTICE: Not a well discussed/listed step, but required nonetheless, is to:

     1. Master (and document)  the Food and Fluid Skills listed on page 37/38 of nutrition section of the handbook.  This section must be filled out and complete prior to surgery approval.

     2.  Purchase and immediately begin consuming daily the recommended pre-surgery Vitamins.  I believe you are to purchase the post-op vitamins too, so that they can confirm you have them prior to surgery.  There is an appointment when you will need to bring all your vitamins with you, possibly your meds too.

    3. Complete written test at the back of the book.


✔  Step Eight 11/28/17  -  Lose 5-10% -  WARNING-Read this step entirely!

     You must lose a MINIMUM of 5% of your highest recorded weight at Kaiser.  Possibly 5% of your current weight if you currently weigh less than your highest recorded weight.

My Highest weight 229.8 lbs - I need to lose 5% -a minimum of -  12 lbs = 217, but they would prefer we lose the full 10% - for me that would be 23 lbs = 206.  Once you reach your 5% pre-op weight loss goal, call to schedule next appointment.

***You MUST have your goal weight documented in your chart by a Kaiser Facility before they will schedule the next step! BEWARE.... you MUST be EXACTLY at or BELOW your goal weight for them to schedule the next step. This actually happened to me. 

I weighed in at kaiser and was 217.6, on the evening of tue 11/28. My goal weight was 217.  I called the next day, wed, just before lunch and they would NOT schedule my next appointment, as I was still over my goal weight.  Nothing I said could change their mind. Luckily I had oddly weighed 214 first thing that morning, so I hung up, stepped on my scale, and it said said 216 due to coffee and breakfast.  I rushed back to Kaiser to get officially weighed in at 216.4.  I called them back and they then scheduled my next step.  First available appointment was 3 weeks out on 12/22.


✔ Step Nine 12/22/17  -  Eval with Psychologist - BEWARE- Before you can call to schedule this appointment you MUST be exactly AT or Below your pre-op goal weight AND you MUST have this documented in your chart by a Kaiser Facility!  See step 8 for mandatory details. This was a good appointment.  They basically want to make sure that you have reasonable expectations, that you understand exactly what is involved, that you have truly been compliant, that you are not bullshitting them or yourself, and that mentally/emotionally you are "ok".  If anyone was going to be denied at this step, it surely would have been me, based on an incident a couple weeks prior to this appointment.  But, she listened to my explanation and I was able to move forward.  After this appointment I had to wait for them to call me to schedule lab work.  After waiting a few days, I called them to give a nudge.


✔ Step Ten 12/29/18  -  Pre-Op test, ekg, labs etc.  Complete lab work and wait minimum 7 days to call to schedule nurse manager appointment.  I called on the 8th day and they couldn't schedule it.  Said the nurse needed to review the lab work and then she would call me to schedule.  I called again the following Monday and then they were able to schedule the nurse manager appointment without a nurse review of my labs "???". I don't know why things seem to "change" willy nilly, but they do.


✔ Step Eleven 1/12/18  -  Meet with Nurse Manager to schedule surgery - 

***This can be NO Sooner than 1 week after you have completed ALL pre-op appointments, labs and tests as ordered.

This was a good appointment. She was very nice and caring.  She reviewed thoroughly my food logs and the vitamins I was required to bring and the "Quiz" at the back of the book.  She is a "detail" blood hound and can sniff out even the teeniest of deviations.  She asked many questions regarding my eating habits and "support" help.  All went well and she scheduled my surgery.  She was thoughtful in that I could have had my surgery a week earlier, but I would have been the last case of the day.  Waiting a week I will be on the schedule early in the day.  Surgery was scheduled 3 weeks and 3 days out, 2/5/18, making it exactly 4 months from the first Bariatric Orientation and 6 mos from the day I decided to have the surgery. 

✔ Step Twelve  1/24/18  -  2hr Pre-Op class - Meet with Surgeon. 

I was told I would need to bring my binder, all my vitamins , and any forms that my employer needs filled out or signed.  All went well, wen't over vitamins (again) received my own personal calendar for post-op diet stages, expectations of surgery day and post op etc.  Then I met with Dr.Y.  All went


 Step Thirteen 2/5/18 -  SURGERY !!

Edited by AliPat

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Wow, very thorough documentation. I'm sure it will help someone.

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Hi AliPat,

I wish I had had your post as a resource when I was researching Kaiser So. Sac's program!  Very thorough.  You are right that the team does not mess around with the requirements of this program.  Either you follow it to the letter, or you do not advance. 

I actually started the program with the 4 hour orientation in December 2016.  I had my appointment with Dr. Y that same day where I was given a goal to lose 12 lbs.  With this program, you are only limited by yourself.  If you lose the weight quickly, you advance quickly.  I had to get out of my own way and that took a while.  I kept telling myself I could lose the weight doing what I always did (i.e., starve myself and exercise).  Shockingly, it didn't work.  Finally, in June 2017, I realized I needed to get with the program, literally, and once I did, the weight came off quickly.  Instead of losing the 12 pounds required, I lost 28.  I had my RNY surgery on 9/11/17 with Dr. Y.  He was absolutely wonderful and I have had zero, absolutely zero, complications.  His incisions are tiny and mine have healed nicely.  I was able to get all of my protein and water requirements in from the beginning and progressed through each of the post-op stages without any trouble.  I'm almost 5 months out and I am losing consistently each week.  I could not be happier. 

One tip I'd offer to you:  take a probiotic starting 10 days before your surgery and continue after your surgery.  I got that bit of info from another member here and I really believe it is what helped heal my gut so that I didn't have gas problems after surgery (only the first two weeks from the gas they inflate your abdomen with which was eased with GasX strips - do walk as much as possible after surgery.  It really does help move the gas out of your body) and has helped me not have any bathroom issues. 

Best of luck to you on your surgery coming up very soon!  Dr. Y is amazing! 

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Wow! Great documentation, @AliPat! Can't believe it's almost here though, can you?  I started my journey mid June and by Nov 6th I was -2/3 of stomach :). It sounds like it will take long from day one but it flies by and suddenly you're drinking liquids then in the hospital! I'm sure your info will be helpful...thanks for journaling and posting it here!

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Props to you, @AliPat. Someone is going to love all the work you put into documenting those steps - nice work! 

Your surgery is in just a few days now. Best of luck on a smooth surgery, a quick and easy recovery, and steady weight loss afterwards! :) 

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On 1/30/2018 at 11:31 AM, Outlander said:

With this program, you are only limited by yourself.  If you lose the weight quickly, you advance quickly.  I had to get out of my own way and that took a while.  I kept telling myself I could lose the weight doing what I always did (i.e., starve myself and exercise).  Shockingly, it didn't work.  Finally, in June 2017, I realized I needed to get with the program, literally, and once I did, the weight came off quickly. 

Ain't that the truth!!  was the same for me.  I only had to lose 7lbs.  I've lost 7lbs like a bazillion times, I thought it would be easy.....NOPE!  The struggle was real... and quite dramatic.

Thanks for the well wishes, And I wish well to all those in the early stages of the journey.  As for me..... I'm heading over to the post -op side now....... giggles!

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