Prattlebangs

Psychology assessment and ongoing input?

Recommended Posts

Hi all,  I live in Australia and am going in for my first appointment with the surgeon tomorrow. All going well I'm having the surgery done through private health insurance,  leaning towards gastric bypass at this stage. Wish me luck!

Does anyone know if it is compulsory to have a psych assessment prior to surgery in Australia? And for those that have had psych input (compulsory or not), haves they found it useful in helping to change their behaviors long term?

Nice to meet you all,  I've been lurking for a few weeks and have found everyone's posts super helpful and inspirational so thank you!

 

Share this post


Link to post
Share on other sites

I was exempted from the pysch assessment as my surgery was deemed a  medically necessary revisional procedure. They generally are compulsory in Australia even in the private system. When I had my original surgery back in 1986, the pysch part of the pre-surgery assessment was actually done by a physician,  so I'm not sure what they actually do these days. At a minimum I do know they are looking to get at your understanding of what the surgery entails, as well as discuss why you want it and what your expectations are. I've never heard of anyone being denied surgery in Australia after their pysch consult, it really sounds to me from the people I know that have had bariatric surgery that the process is about having realistic expectations of the outcomes of surgery and the importance of personal self control regarding food choices and exercise.

Good luck with tomorrow's appointment. I'm sure your surgeon will be able to answer any questions regarding his prerequisites.  Expect a pysch visit, nutritionist appointments,  and possibly exercise physiologist appointments. The private clinics usually have all these folk within their centre. There'll be lots of bloodwork which they may well get started on tomorrow,  potentially a sleep study if they suspect sleep aponea, at minimum an EKG will be conducted before surgery, and if that's not perfect they'll send you for further cardiology testing before surgery and require the cardiologist to sign off on you before they'll operate. Testing can also include an endoscopy, possibly and abdominal CT Scan, perhaps even a barium swallow test. Some hospitals will expect all patients to have a chest xray prior to surgery so that is also a possibility.

As I said my surgery was different this time around as it was a revision, but I had extensive bloodwork, an EKG, and endoscopy prior to scheduleing the surgery. I'd already had an abdominal CT ordered by a different specialist prior to my booking appointment so the surgery just had the xray place make that available to his computer, plus he'd ordered a barium swallow months before so had that available to him also. Some surgeon's even in the private system will require a degree of weightloss before they'll schedule you for surgery as an indication that you can change your lifestyle......and everyone has to undergo some degree of liver shrinking diet in the weeks before surgery.....there is simply no getting around this as it is a surgical safety requirement.

Edited by Aussie Bear
Autocorrect!!!!!!!

Share this post


Link to post
Share on other sites

Evaluation and clearance by a mental health care professional (psychiatrist, psychologist or therapist) is pretty much standard practice in the US too.

It's basically to assess our readiness, behavioral challenges, and possible emotional factors that may impact life after WLS.

Share this post


Link to post
Share on other sites
8 hours ago, cinwa said:

Evaluation and clearance by a mental health care professional (psychiatrist, psychologist or therapist) is pretty much standard practice in the US too.

It's basically to assess our readiness, behavioral challenges, and possible emotional factors that may impact life after WLS.

I think the only real difference between Australia and the US in regard to bariatric surgery approval is that here in Australia the insurer has no say in the approval process..... If your policy covers bariatrics....then you're covered!!!! The individual surgeon decides whether they'll approve your surgery or not, so they are the ones that make the rules, usually in line with the standards set by the Australian Metabolic and Obesity Surgery association (or something to that effect). If they're happy to approve you it's a simple case of checking their diary and scheduling it. Unfortunately in Australia there is usually a huge co-payment for bariatric surgery in the private sector.....expect to have parted with at least $5000 in out of pocket expenses before surgery and that's with top table cover...lower tables will cost even more excuse that co-payment doesn't include any hospital co-payment. Some surgeon's will say the high co-payment gives the patient an investment in making their surgery work, as well as ensuring attendance at follow up appointments because these are usually prepaid in this up front co-payment .....let's be honest here though in that it is really just the surgeons lining their pockets.

Edited by Aussie Bear

Share this post


Link to post
Share on other sites

Thanks for the info Aussie Bear and cinwa. I had my appointment yesterday. Slightly underwhelmed. Nothing rang alarm bells specifically but other than a discussion about the types of surgery there didn't seem to be much info or organisation and only very minimal testing required i.e. blood tests only. I should be pleased that it's so easy but honestly I would like to know that everything is ok before going in for surgery! They also didn't actually give me referrals for blood tests,  seemed vaguely interested in booking next appointment and other than dietitian no other follow up. 

Should I be concerned and look for a different surgeon? This one has all the right training,  experience,  professional affiliations etc but as mentioned,  lacking in anything other than absolute basics of assessment and follow up. 

I should mention that other than having a bmi of 41 I don't have any other issues (yet), or at least none diagnosed!

Edited by Prattlebangs

Share this post


Link to post
Share on other sites

If you feel like you are going to need more support than on first appearances this surgeon offers, then I would both ask more questions of the staff, and look for other recommendations. I understand your logistics being in Tassie, but you should be able to get more questions resolved over the phone. My sister is having revisional surgery next week with a well known and highly credentialed Adelaide surgeon, and she has had very little testing done as well. However, she did have her lapband removed three months ago and that was an opportunity for the surgeon to have a good look around the abdomen and plan her revision.....that's what the surgeon told her anyway. Her BMI was quite low (around 35) and no known comorbidities,  so maybe that's why the lack of testing. I really have no clue what testing she'd had prior to her first surgery because she kept that procedure secret then, but her surgeon certainly would have access to that given it was only about 3 years ago. My nephew in law used the same clinic and had far more testing pre-op,  along with a very strict (and large) preop weight loss requirement.  His BMI would have been (at a guess) around the 70s though.

In Australia surgeons tend not to have support groups pre-op,  and most do a poor job post-op as well from what I've seen and heard. That said, you might be one of those people (like me) that doesn't need hand holding, is happy to research answers themselves, and in my case anyway would get very easily annoyed by people at support groups.....I have little patience and a well know inability to suffer fools. If however you are the type of person that needs handholding and regular contact with the surgeon, then maybe a different surgical practice would be better suited to your needs. In my opinion post surgery a great GP is more important.  They can order and manage all your followups like blood tests, scans if deemed necessary etc. My experience has been that surgeons usually do the cutting and then lose interest in you once that job is done, so it's back with the GP anyway. Up until now I've been lucky that my surgeon visits my backwater home town regularly to perform general surgery, and he'll often follow me up....Mine was a pretty rare case for surgeons to see now as it was such an old surgical technique most surgeons had never even learned about let alone seen, so the surgeon seems interested in following me for as long as he can. He doesn't usually see his surgical patients after their initial post surgical check, as in the public hospital they are dealt with by outpatient clinics....and not very well dealt with from what I've been told. My GP has really been managing blood tests and referrals to other specialists that I've needed post surgically.

Share this post


Link to post
Share on other sites

Thanks Aussie Bear. Yes, I am in Tassie, the surgeon I went to see is in Melbourne though as there are very few bariatric surgeons down here and none that do the bypass I don't think. I have decided to go ahead with this surgeon. As you say, I am not one that needs hand holding and am quite happy following things up for myself so I have found a psychologist (in Brisbane) who specialises with weight loss surgery patients and can do sessions over skype. I'm pretty happy to get information and run with it myself but I feel like psych input is probably fairly important as I obviously haven't been able to get my eating under control myself regardless of how much I know about healthy eating, exercise and the implications of unhealthy behaviours. If I'm going to have this surgery then I'm going to make sure I give myself every chance of actually maintaining my weight loss long term! And it's not the losing weight bit I am concerned about, it's the maintenance as that is what I have never been able to do even when I do get down to my goal weight.

I think you're right about surgeons, they absolutely lose interest as soon as the surgery is over. You must have had a very interesting initial surgery for your surgeon to continue following up for so long!

Share this post


Link to post
Share on other sites
2 hours ago, Prattlebangs said:

 

I think you're right about surgeons, they absolutely lose interest as soon as the surgery is over. You must have had a very interesting initial surgery for your surgeon to continue following up for so long!

I think he uses me as a teaching opportunity that he otherwise wouldn't have had. My surgeon is head bariatric surgeon at a major teaching hospital in Adelaide which is where I had my surgery. It felt like every man and their dogs were in the operating theatre the day I had surgery....I've never seen that many people in my life. He doesn't normally see bariatric patients in my local hospital, so I'm a change of pace for him when he does a general surgery rotation here, and recently he's started getting students in when I visit. There were lots in theatre when I recently had an endoscopy to check for a possible stricture. I only waited 5 months for my surgery in the public hospital system, and it usually has a 5 year waiting list, so I'm very happy with the treatment I've received so far. I wasn't looking for a revision when I saw him first, but luckily he was the surgeon scheduled to do an endoscopy when my reflux was out of control,  and when he discovered the mess my original surgery was in due to stapleline dehiscence,  the need to revise was obvious. The surgeon also timed my surgery so once released from hospital and allowed to return home, he would be in my home town on his regular rotation in case there were any complications. At 18 months post-op though, I suspect he's lost interest in me now.

The bariatric practice my sister uses also uses a pysch that does his consults via Skype..... I think her guy is Canberra based but I could be mistaken on that. 

Share this post


Link to post
Share on other sites

 

56 minutes ago, Aussie Bear said:

 I wasn't looking for a revision when I saw him first, but luckily he was the surgeon scheduled to do an endoscopy when my reflux was out of control,  and when he discovered the mess my original surgery was in due to stapleline dehiscence,  the need to revise was obvious. 

What was the original surgery you had? And was it successful in the beginning or were there complications from the start?

Share this post


Link to post
Share on other sites
12 hours ago, Prattlebangs said:

 

What was the original surgery you had? And was it successful in the beginning or were there complications from the start?

I had a Gastroplasty.... the original stomach stapling procedure in 1986. I did lose quite a lot of weight in the beginning but over the years regained it all. I take complete responsibility for my regain but the surgeon did say that it was a procedure that they later discovered didn't work. He said most people that had that surgery were revised to bypass within 5 years due to stapleline dehiscence.  Hence surgeon's these days just don't see it anymore. He did say my pouch wasn't stretched and the tissue was healthy still, it was just that my stoma (the opening from the pouch to the rest of my stomach) was scarred over and the staple line had burst open as a consequence.  I was very lucky according to him as that surgery had an early mortality rate of around 10%. I recall going down to a size 16 at the time before I started having babies. This time I'm currently in size 10 clothes.

Share this post


Link to post
Share on other sites

Yikes, just looked up that surgery,  looks crazy... they create a hole in the stomach for the band to go through and staple the side?

Sounds like you very lucky! Did you know.. did they know(?!)... it was a 1 in 10 risk of early mortality?

Sounds like you've done an amazing job both after the first surgery and the revision though.

I lost about 40kg and got down to a size 10-12 about 10 years ago and felt awesome! I seem to manage you lose the weight about every 7 years and get to goal weight, I just can never keep it off for more than a few months and spend most of my time in the obese weight range. Hence my concern and desire for psych input to help me make the behavioral changes I know are needed for lifelong maintenance.

Share this post


Link to post
Share on other sites
5 hours ago, Prattlebangs said:

Yikes, just looked up that surgery,  looks crazy... they create a hole in the stomach for the band to go through and staple the side?

Sounds like you very lucky! Did you know.. did they know(?!)... it was a 1 in 10 risk of early mortality?

Sounds like you've done an amazing job both after the first surgery and the revision though.

I lost about 40kg and got down to a size 10-12 about 10 years ago and felt awesome! I seem to manage you lose the weight about every 7 years and get to goal weight, I just can never keep it off for more than a few months and spend most of my time in the obese weight range. Hence my concern and desire for psych input to help me make the behavioral changes I know are needed for lifelong maintenance.

That's not what I had. Mine was a stapleline that went across the stomach on a slight vertical slant with an opening left at the bottom. The stomach was left intact except for the staples. As for the mortality rate, I don't recall being told...but I doubt I would have cared anyway. I actually backed out of surgery the night before ( back then you were admitted the day before surgery to ensure you fasted). Was stopped from leaving by the anesthecist when he visited. He told me I need my gall bladder removed  due to a stone the size of a golf ball, which I also didn't know about as I hadn't seen the surgeon after my ultrasound. So I stayed to have the gallbladder removal and figured as they were opening me up anyway (no laprascopic surgery back then) I may as well get the stapling while they were in there.

Share this post


Link to post
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now