Transcription:

Prakash Chandran (Host):  If you’re considering the bariatric or weightloss surgery, you need to make sure you understand the process before, during and after surgery to ensure your success. We’re going to learn about it today with Terry McKenzie, a Bariatric Coordinator and Certified Bariatric Nurse at North Florida Regional Medical Center. This is Helmet of Health, the podcast from North Florida Regional Medical Center. I’m Prakash Chandran. So, first of all Terry, let’s start with the basics here. what exactly is bariatric surgery?

Terry McKenzie, RN, CBN (Guest):  Bariatric surgery is where we go and modify the shape and size of your stomach so that you can eat less and lose weight.

Host:  Okay and what steps should a person take if they’re first interested in getting bariatric surgery?

Terry:  Well the process that we use is the first thing you can call us, you do not require being referred by your primary care, certainly you can call us yourself. Once you call us, the first thing we want to do is verify your insurance benefits and we do that primarily because the next few steps you need to take you don’t want to have to do if it’s not a covered benefit. After that, plus insurance companies will require some things that we, as an accredited center do not. So, we want to know exactly what you need so that we can help you accomplish that.

The second thing is that we have a mandatory new patient orientation seminar that we have all of our patients attend. And in there, we go over what the expectations are, not only what you can expect from us but what we can expect from you, what you need to do, and we talk about the surgeries and we are very honest about how we talk about surgeries. I talk about the good, the bad and the ugly. I do not sugar coat anything. And then our dietician talks about some of the dietary changes. That way when you have a consultation appointment with a surgeon; you have some knowledge so you can ask the questions that are going really pertain to you and the surgery you are interested in.

Host:  Yeah, it’s good to hear that there’s so much prep work and education that is done before you even get to the surgeon in terms of like that communication and just knowing what you’re getting yourself into. I’m curious as to if there’s any diagnostics or preoperative work that the patient needs to be aware of before considering a surgery like this.

Terry:  We have a patient obtain a thyroid screening and what’s called a TSH bloodwork from their primary care physician to make sure they do not have untreated hypothyroidism. And the primary reason is that if it’s untreated; it could affect their ability to lose weight. You can have hypothyroidism, but we just want to make sure it’s being treated properly. We also have them do a psychological evaluation with a licensed psychologist or psychiatrist again, to make sure there any underlying psychological issues that in doing surgery we can do them more harm than good. Other than that, any other preop tests are going to be based on their medical history. So, once they’ve had a consultation with the surgeon; and then we get them ready to actually have a surgical date; we will schedule an EKG, some lab work and whatever else the surgeon deems necessary based on that patient’s medical and surgical history.

Host:  Understood. And I believe that there are three different types of surgeries. So, in the preoperative work, is that where you determine the type of surgery that a patient should undergo before they see the surgeon?

Terry:  Yes. Once the – the patients usually have an idea of what they are interested in and when they come to their consultation visit; we will have their medical and surgical history. The surgeon will have that information in from of him when he discusses surgical options with that patient. And they will make sure that again, that the surgery that we’re going to do isn’t going to be the wrong surgery for that patient. There are certain medical conditions that could not always, but that could delete a certain procedure for someone. If you have extreme acid reflux, you may not want the sleeve gastrectomy because it may just make that worse. But it may not, so that’s a good reason to talk with the surgeon and discuss surgical options and be open to potential changes in those.

Host:  And on average, for the most common procedures, how long does a bariatric surgery take and how invasive is it?

Terry:  Well the lap band, which is a minimally invasive, that takes about 30 minutes of surgical time once you’re under anesthesia. The sleeve gastrectomy which is the next one is more invasive. That takes about an hour and then the gastric bypass which is the most invasive of the three procedures we perform; would take about two to two and a half hours.

Host:  I see. So, if someone is listening to this and they’re doing their research and they’re making considerations to get bariatric surgery; what is your best advice to them to help them be better prepared for the surgery?

Terry:  Well of course starting to move around a little bit more is always an advantage. If you smoke, please stop smoking. That is going to interfere with your ability to recover faster. And of course it’s just not good for all kinds of reasons. I think the best thing a patient can do to prepare for any surgery is to educate themselves. A lot of times, folks either look at what’s on the internet or they talk to friends and oh this friend had this surgery and they did great. Not every surgery is the right fit for every person. Depending on their lifestyle and their ability to make changes. That’s what we try to tell people when they come for the orientation is look at what this is. Understand what you have to do to be successful. And see which one works for you, not what works for everybody else but what is going to work for you.

Host:  One thing that you touched upon there that I don’t think a lot of people realize is that it’s a complete change in lifestyle after the surgery is done. It’s not like the surgery is done and then all problems go away. It’s something that you have to really monitor your diet and also check back in with you all at the hospital just to make sure that everything is on track on a frequent basis. Isn’t that correct?

Terry:  That is. And it’s not – and we try to tell people that they need to make dietary changes but that does not mean they have to diet from this point on. But what they have to remember is that they’re going to have an extremely smaller stomach than what they had preoperatively. So, they have to learn to eat from the neck down basically. We tell people right now you’re eating from the neck up which is looks good, tastes good, smells good, it’s on. But you need to change that and start eating from the neck down which is listening to your stomach. Because every time your stomach growls does not mean it’s hungry, it could just be thirsty, it could just be digesting. So, you need to listen to your stomach. You need to eat slowly and get that sense of when you are no longer hungry. Which is kind of a void hungry and full and then in the middle is the not hungry. So, it’s kind of like learning to eat all over again and then you want to start with eating the right foods first. You want to eat your protein first. And then you want to eat your vegetables and save your fatty foods for last. That way, you are getting the most bang for your buck.

Host:  All right Terry, well this has been super informative today. Thank you so much for your time. That’s Terry McKenzie, a Bariatric Coordinator and Certified Bariatric Nurse at North Florida Regional Medical Center. Thanks for checking out this episode of Helmet of Health. Head to www.nfrmc.com to get connected with a provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and we’ll talk next time.