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Prime Care Surgical Weight Loss Program

Prime Care Surgical Weight Loss Program. “A comprehensive program integrating body, mind & spirit” Brandon Helbling, M.D., F.A.C.S. Gaylord Kavlie, M.D., F.A.C.S. Kay Wanner, LRD CDE

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Prime Care Surgical Weight Loss Program

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  1. Prime Care Surgical Weight Loss Program • “A comprehensive program integrating body, mind & spirit” • Brandon Helbling, M.D., F.A.C.S. Gaylord Kavlie, M.D., F.A.C.S. • Kay Wanner, LRD CDE • Jean Ellefson, RN Jessica Miller, RN, BSN, CPAN • MDC Clinical Coordinator SAMC Clinical Coordinator • Archway Mental Health Services • Dr. Lea Berentson, Psy.D. Dr. David Brooks, Ph.D., ABPP(RP), • ABN, FACE, FACAPP • Affiliated With:

  2. Dr. Brandon Helbling Dr. Gaylord Kavlie

  3. Session Outline • Examining the Disease of Obesity • Benefits of Surgical Weight Loss • SWL options: Lap Band, Gastric Bypass, Sleeve Gastrectomy • Frequently Asked Questions • Pre-Op Expectations • Nutrition • Eligibility and Insurance Requirements

  4. Mission Statement To provide support to those committed to a healthier lifestyle and improved quality of life through medical and surgical treatment of obesity.

  5. What Our Program Offers: • Education on surgical weight loss options • Evaluation by a laparoscopic bariatric surgeon • Psychological evaluation • Pre-operative nutrition class • Consult with the Bariatric Clinical Coordinator • Financial counsel • Pre-authorization with your insurance provider • Post-op visits with surgeon to check progress • Consult with a physical therapist • Support group monthly meetings • Online support group twice monthly • Online pre and post-op education with programs to track your progress AND THERE’S MORE

  6. What Our Program Offers: Our Bariatric Nutrition Program offers: • Lap Band: 1 month post-op class (1 hr) • Gastric Bypass: 2 weeks & 6 weeks post-op visit with dietitian, 3 month post-op class (1 hr) • Sleeve Gastrectomy: 2 weeks post-op visit with dietitian, 6 weeks post-op class (1 hr) These post op visits and classes include: • Behavior modification instructions and information • Exercises to stress all muscle groups for better calorie burning • Handouts, information packets • Coupons for additional visits with the dietitian if you have reached a plateau and/or need some help

  7. DEFINITION OF OBESITY “A life-long, progressive, life threatening, genetically-related, costly, multi-factorial disease of excess fat storage with multiple co-morbidities (obesity related health conditions).”

  8. Magnitude Of The Problem • 66% of Americans are overweight • 97 million Americans are overweight or obese • Can reduce a person’s life expectancy by 20 years • Second leading cause of preventable death in America killing 300,000 annually • Based on current obesity rates, researchers predict that nearly the entire U.S. population could be overweight by 2030. (USA TODAY - OCTOBER 2002)

  9. Obesity Related Effectson Lifestyle • Health – Mortality is increased 50-100% in obese individuals • Economic – Spend 77% more on medications • Physical – Mobility and pain -for every 2 lbs gained, risk for arthritis increases 9-13% • Psychological – Depression increases with obesity • Social – Isolation and stigma • It is becoming realized as a disability.

  10. 1994 2000 1994 2000 No Data <4.5% 4.5%–5.9% 6.0%–7.4% 7.5%–8.9% >9.0% No Data <14.0% 14.0%–17.9% 18.0%–21.9% 22.0%–25.9% 26.0% Age-adjusted Prevalence of Obesity and Diagnosed Diabetes Among U.S. Adults Aged 18 Years or Older Obesity (BMI ≥30 kg/m2) 2010 Diabetes 2010 CDC’s Division of Diabetes Translation. National Diabetes Surveillance System available at http://www.cdc.gov/diabetes/statistics

  11. What Is Morbid Obesity? • Clinically severe obesity at which point serious medical conditions occur as a direct result of the obesity • Defined as >200% of ideal weight, >100 lb overweight, or a body mass index of 40

  12. Degrees of Obesity NORMAL BMI 18.5 –24.9 OVERWEIGHTBMI 25 –29.9 OBESEBMI 30 –34.9 SEVERE OBESEBMI 35 –39.9 MORBIDLY OBESE BMI  40

  13. Do You Know Your Own BMI?

  14. Medical Complications of Obesity Idiopathic intracranial hypertension Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Stroke Cataracts Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Coronary heart disease Diabetes Dyslipidemia Hypertension Severe pancreatitis Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Phlebitis venous stasis Skin Gout Source: www.obesityonline.org

  15. Surgical Weight Loss At present surgery is our most effective option in achieving SUSTAINED weight loss in the morbidly obese patient. “Not a Miracle”

  16. Medical Benefits of SWL • Type II Diabetes 76.8% remission rate, significantly improved in 86% • High Blood Pressure eliminated in 61.7%, significantly improved in 78.5% • High Cholesterol reduced in more than 70% of patients • Sleep Apnea eliminated in 85.7% of patients • Joint Disease, Asthma, and Infertility dramatically improved or resolved • Plus many other important medical benefits JAMA 2004

  17. NORMAL DIGESTIVE SYSTEM

  18. PrimeCare Weight Loss Program Surgical Options • Restrictive only: • Adjustable Gastric Banding • Sleeve Gastrectomy • Restrictive and Malabsorptive: - Roux-en-Y Gastric Bypass

  19. Laparoscopic Adjustable Gastric Banding • A siliconeband is placed around the upper part of the stomach • The band is attached to a port • A small pouch is created • Stomach holds less food • Induces feeling of satiety • OR time = 30-45 minutes • Generally outpatient procedure • Return to work in 3-5 days • Frequent evaluations and adjustments needed to meet individual needs

  20. The “Green Zone”

  21. Possible Complicationsof Lap Banding Stomach Perforation Device Malfunction Esophageal Dilation Obstruction Erosion Prolapse Slippage Infection

  22. The LAP-BAND System • Advantages • Adjustable – customized per patient • No stomach stapling, cutting or intestinal rerouting • Removable and reversible • Low malnutrition risk • OR time = 1 hour or less • Generally outpatient procedure • Disadvantages • Slower initial weight loss than gastric bypass • Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss. • Regular follow-up is critical for optimal results • Only trained practitioners can do adjustments • Foreign body

  23. Roux-en-Y Gastric Bypass • Combination restrictive and minor malabsorptive procedure • First done in 1967, done laparoscopically since 1993 • Gastric pouch is approximately size of your thumb ASMBS

  24. SUCCESS OF GASTRIC BYPASS SURGICAL TREATMENT • In a 5 Year Study of 500 Roux En Y Surgical Weight Loss Patients: • 77% Of Excess Body Weight Was Lost in 1 Year & Maintained For 60 Months • 96% Of Severe Co-Morbidities Were Eliminated Within 1 Year • 98% Of Type II Diabetes Was Clinically Reversed Dr.’s Wittgrove & Clark, 1993 - 1999

  25. POSSIBLE SURGICAL COMPLICATIONS OF GASTRIC BYPASS • Abscess • Deep Vein Thrombosis • Pulmonary Emboli • Gastric Leaks • Bleeding • Development of a Fistula • Obstruction • Pulmonary Complications • Infection • Hernias • Strictures • Stomal Ulcers • Ventral Hernia • Anemia • Vitamin & Mineral • Deficiencies • Perforation

  26. Gastric Bypass Advantages Rapid initial weight loss More effective, rapid co-morbidity improvements Food restriction with the added weight loss benefit of minor food malabsorption Better long term weight loss results than restrictive only procedures Assists those who consume too many calories by making them ill – “dumping” Disadvantages Cutting and stapling of stomach and bowel is required More operative & post-op complications Portion of digestive tract is bypassed, reducing absorption of essential nutrients Nonadjustable, difficult to reverse

  27. Sleeve Gastrectomy • Restrictive procedure • 85% of the stomach is removed • Stomach that remains is shaped like a banana and measures 2-5 ounces

  28. POSSIBLE SURGICAL COMPLICATIONS OF SLEEVE GASTRECTOMY • Deep vein thrombosis • Pulmonary embolus • Pneumonia • Acute respiratory distress syndrome • Accidental perforation of internal organs • Gastric leak • Postoperative bleeding

  29. Sleeve Gastrectomy Advantages Stomach is reduced in volume but tends to function normally. Most food items can be consumed in small amounts. Eliminates the portion of the stomach that produces the hormones that stimulate hunger (Ghrelin). No dumping syndrome because the pylorus is preserved. By avoiding the intestinal bypass, protein deficiency and vitamin deficiency are almost eliminated. Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures. It can be converted to almost any other weight loss procedure. Disadvantages Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss. Potential for leaks related to long staple line on the stomach. Because part of the stomach is removed, it is not reversible.

  30. Frequently Asked Questions About Bariatric Surgery.... Q: Is Weight Loss Surgery Reversible? A: Lap Band- Yes Gastric Bypass- No Sleeve Gastrectomy- No Q: Is There Guaranteed Success? A: No. These surgeries can be defeated if healthy lifestyle changes are not maintained.

  31. More Frequently Asked Questions Q: Will you take my gallbladder out whenyou do my surgery? A: No. We do not remove healthy gallbladders. If you have evidence of stones or disease it may be removed. Q: What are the age limits for these surgery? A: 18 is the youngest. Patients up to age 65 have had these surgeries, however, all patients are individually considered.

  32. More Frequently Asked Questions Q: When can I go back to work? A: Depends- based on the procedure done and the type of work you do. Q: When can I drive? A: When off of narcotic pain medication. Q: When can I exercise? A: Walking is recommended in moderation immediately after surgery. 6 weeks for more intense exercise.

  33. More Frequently Asked Questions Q: Can I drink alcohol? A: No beer because of carbonation. Wine and other alcoholic beverages are fine but contain many empty calories. Q: Am I going to have loose skin after I lose weight?A: Probably. Reconstructive surgery to correct this is usually covered by insurance if you lose 100 pounds or more.

  34. Mission Statement To provide support to those committed to a healthier lifestyle and improved quality of life through medical and surgical treatment of obesity.

  35. Nutrition Kay Wanner, LRD, CDE Diabetes & Nutrition Center Mid Dakota Clinic

  36. Pre-Operative Expectations • Goals of optimum weight loss during the pre-op period: • Reduce liver size • Increase the odds that surgery can be completed laparoscopically • Demonstrate commitment to the nutritional program that has been prescribed for you • Demonstrate your commitment to making lifestyle changes.

  37. Preparing for Surgery(Roux-en-Y Bypass, Sleeve Gastrectomy and Lap Band) 2 weeks before surgery • Protein shake 2x/day • 1 meal with meat & vegetables each day • Multivitamin 2x/day • Discontinue herbal supplements. • 24 hours before surgery, clear liquids only.

  38. Required Daily SupplementsRoux-en-Y Gastric Bypass Two weeks post-op (Gastric Bypass only): • Multivitamin/mineral • Calcium citrate • Iron • Foltx These need to be continued for the rest of your life.

  39. Required Daily Supplements for Lap Band and Sleeve Gastrectomy Third Post-op Day: Lap Band • Chewable Multiple Vitamin / Mineral tablet Sleeve Gastrectomy • 1000mcg B12 daily • Chewable Multiple Vitamin / Mineral tablet

  40. Lifetime Rules for Eating • Eat slowly and chew well • Avoid overeating • Moisture rich foods • Limit sugar and high fat foods • Total of 64 oz. fluid daily, taken between meals • Avoid carbonated beverages- includes beer • Take your prescribed supplements

  41. Jean Ellefson, RN MDC Clinical Coordinator Surgical Weight Loss Program(701)530-63301-800-472-2113, ext. 6330Fax: (701)530-6387

  42. Eligibility • Height • Weight • Health issues • Insurance company

  43. Insurance Requirementsfor Pre-Authorization • Surgical Evaluation • Psychological Evaluation • Pre and Post-Op Nutrition with LRD • Documented weight loss attempts • Documented health issues and previous weight history

  44. Set the Date! Usual time line: • 5-6 weeks for BCBS and most commercial insurance • 2-3 months for Medicaid

  45. Financial Responsibility • Insurance *Deductible *Out of pocket maximum (co-insurance) *Call the customer service number *Adjustments/Lap Band • Self Pay *Care Credit *Lap-Band $15,675 *Sleeve Gastrectomy $15,750

  46. Exercise Supportprovided byMid Dakota Clinic Nutrition Department

  47. Comprehensive Program is a must for SUCCESS!

  48. What to do next? • Pick up packet • Fill out entirely • Call MDC Clinical Coordinator (Jean) at (701)530-6330 to schedule an appointment

  49. Jessica Miller, RN, BSN, CPANBariatric CoordinatorSt. Alexius Medical Center (701) 530-5189 1-800-222-4036, Ext. 5189 Updated 8/26/14

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