Guest guest Posted May 23, 2006 Report Share Posted May 23, 2006 , Your program is not too strict. I have worked in two different programs and one program required a 5% wt loss prior to surgery and the other program I am in now requires a 10% wt loss prior to surgery. There are a lot of benefits to having them lose weight prior to the surgery. One being that they lose abdominal fat and the liver is lighter and it makes the surgery a little easier for the doctor. I used to have them practice a pureed diet and practice eating slowly etc. Sounds like you are doing a good job with your program. Keep it up. On 5/23/06, julielewrd <jlewis@...> wrote: Do any other bariatric centers require a specific weight loss, like 5% BW prior to surgery? Very curious to find out. The main reason is we just hired a new RN who is also a RNY post-op and is being very critical of how we run our program. She states that she would not have gone through our program because we have our patients jump through too many hoops. The program where she had her surgery did not have her do anything pre-op and she only saw a RD 1x. Granted, she has lost a lot of weight and looks great, she has an atrocious diet. I would not want our patients to see what she eats!We require a 5% wl prior to scheduling a surgery date. Usually our patients can do this while waiting for insurance approval. After the weight loss is achieved, insurance is approved and a surgery date is set, we start a VLCD for 2 weeks. We have been doing it this way for 2 years with very good results, yet not a lot of numbers, obviously. Only between 60-70 surgeries (RNY and AGB). We pride ourselves on being a strict comprehensive program and our post-ops all agree that they are glad they learned how to take care of themselves before surgery. In fact, I tell my patients that " you can't perform a play or win a game without practicing. " I have our patients " practice " like they have a pouch and only eat foods that they will be able to tolerate after surgery. Usually, eating that way provides a 5% weight loss very quickly. I also have them weigh-in at our office every 2 weeks and bring food journals, which I review and chart on. Our surgeon relies heavily on my report of how well a patient is doing with my diet protocols.I really would like to know other RD's view on this. Is this being too strict? I know that there is no sound research that states a WL prior to surgery is an indication of post-op success. I just can't believe that it would not help.I would appreciate any opinions. Thanks. , RD, CD Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2006 Report Share Posted May 23, 2006 Hi , I was very interested to read about your program. We, too, set up our program with lots of pre-op time to prepare for long term success. I have contracts that the patients sign at each visit with me. The first contract states that we expect 3% wt loss before surgery. Patients often become discouraged when they see that and state that they won't be able to do it since they can't lose weight. However, if I can get them past that initial reluctance they almost always surpass the expected 3%. And, as they do, they gain confidence in their ability to lose weight, one of the most important indicators of long-term success in my opinion. We have recently added to our regular 3 monthly pre-op nutrition education visits a 2-4 week VLCD. We see rapid wt loss during this phase. Of course, we too meet with resistance from staff members who feel that it is more important to increase volume and the best way to do so is to expedite the time required before surgery. I am afraid that will be the way of the future as pressure to meet volume to qualify to become a COE increases. Nice to hear from someone else in the same boat. Sandi Birch, RD LD EIRMC, New U Program Idaho Falls, ID foodycoach@...julielewrd <jlewis@...> wrote: Do any other bariatric centers require a specific weight loss, like 5% BW prior to surgery? Very curious to find out. The main reason is we just hired a new RN who is also a RNY post-op and is being very critical of how we run our program. She states that she would not have gone through our program because we have our patients jump through too many hoops. The program where she had her surgery did not have her do anything pre-op and she only saw a RD 1x. Granted, she has lost a lot of weight and looks great, she has an atrocious diet. I would not want our patients to see what she eats!We require a 5% wl prior to scheduling a surgery date. Usually our patients can do this while waiting for insurance approval. After the weight loss is achieved, insurance is approved and a surgery date is set, we start a VLCD for 2 weeks. We have been doing it this way for 2 years with very good results, yet not a lot of numbers, obviously. Only between 60-70 surgeries (RNY and AGB). We pride ourselves on being a strict comprehensive program and our post-ops all agree that they are glad they learned how to take care of themselves before surgery. In fact, I tell my patients that "you can't perform a play or win a game without practicing." I have our patients "practice" like they have a pouch and only eat foods that they will be able to tolerate after surgery. Usually, eating that way provides a 5% weight loss very quickly. I also have them weigh-in at our office every 2 weeks and bring food journals, which I review and chart on. Our surgeon relies heavily on my report of how well a patient is doing with my diet protocols.I really would like to know other RD's view on this. Is this being too strict? I know that there is no sound research that states a WL prior to surgery is an indication of post-op success. I just can't believe that it would not help.I would appreciate any opinions.Thanks. , RD, CD New Messenger with Voice. Call regular phones from your PC and save big. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2006 Report Share Posted May 23, 2006 Hi , I was very interested to read about your program. We, too, set up our program with lots of pre-op time to prepare for long term success. I have contracts that the patients sign at each visit with me. The first contract states that we expect 3% wt loss before surgery. Patients often become discouraged when they see that and state that they won't be able to do it since they can't lose weight. However, if I can get them past that initial reluctance they almost always surpass the expected 3%. And, as they do, they gain confidence in their ability to lose weight, one of the most important indicators of long-term success in my opinion. We have recently added to our regular 3 monthly pre-op nutrition education visits a 2-4 week VLCD. We see rapid wt loss during this phase. Of course, we too meet with resistance from staff members who feel that it is more important to increase volume and the best way to do so is to expedite the time required before surgery. I am afraid that will be the way of the future as pressure to meet volume to qualify to become a COE increases. Nice to hear from someone else in the same boat. Sandi Birch, RD LD EIRMC, New U Program Idaho Falls, ID foodycoach@...julielewrd <jlewis@...> wrote: Do any other bariatric centers require a specific weight loss, like 5% BW prior to surgery? Very curious to find out. The main reason is we just hired a new RN who is also a RNY post-op and is being very critical of how we run our program. She states that she would not have gone through our program because we have our patients jump through too many hoops. The program where she had her surgery did not have her do anything pre-op and she only saw a RD 1x. Granted, she has lost a lot of weight and looks great, she has an atrocious diet. I would not want our patients to see what she eats!We require a 5% wl prior to scheduling a surgery date. Usually our patients can do this while waiting for insurance approval. After the weight loss is achieved, insurance is approved and a surgery date is set, we start a VLCD for 2 weeks. We have been doing it this way for 2 years with very good results, yet not a lot of numbers, obviously. Only between 60-70 surgeries (RNY and AGB). We pride ourselves on being a strict comprehensive program and our post-ops all agree that they are glad they learned how to take care of themselves before surgery. In fact, I tell my patients that "you can't perform a play or win a game without practicing." I have our patients "practice" like they have a pouch and only eat foods that they will be able to tolerate after surgery. Usually, eating that way provides a 5% weight loss very quickly. I also have them weigh-in at our office every 2 weeks and bring food journals, which I review and chart on. Our surgeon relies heavily on my report of how well a patient is doing with my diet protocols.I really would like to know other RD's view on this. Is this being too strict? I know that there is no sound research that states a WL prior to surgery is an indication of post-op success. I just can't believe that it would not help.I would appreciate any opinions.Thanks. , RD, CD Sneak preview the all-new .com. It's not radically different. Just radically better. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2006 Report Share Posted May 23, 2006 Thanks so much! It's good to hear when your colleagues approve of the job you are doing. I'm going to forward these responses to my director. We too are striving for COE and I just don't understand what the number "125" has to do with the eligibility of a bariatric center. Take care, , RD, CD Memorial Weight Loss & Bariatric Surgery Center South Bend, IN From: [mailto: ] On Behalf Of Sandi BirchSent: Tuesday, May 23, 2006 2:14 PM Subject: Re: WL before surgery Hi , I was very interested to read about your program. We, too, set up our program with lots of pre-op time to prepare for long term success. I have contracts that the patients sign at each visit with me. The first contract states that we expect 3% wt loss before surgery. Patients often become discouraged when they see that and state that they won't be able to do it since they can't lose weight. However, if I can get them past that initial reluctance they almost always surpass the expected 3%. And, as they do, they gain confidence in their ability to lose weight, one of the most important indicators of long-term success in my opinion. We have recently added to our regular 3 monthly pre-op nutrition education visits a 2-4 week VLCD. We see rapid wt loss during this phase. Of course, we too meet with resistance from staff members who feel that it is more important to increase volume and the best way to do so is to expedite the time required before surgery. I am afraid that will be the way of the future as pressure to meet volume to qualify to become a COE increases. Nice to hear from someone else in the same boat. Sandi Birch, RD LD EIRMC, New U Program Idaho Falls, ID foodycoach@...julielewrd <jlewis@...> wrote: Do any other bariatric centers require a specific weight loss, like 5% BW prior to surgery? Very curious to find out. The main reason is we just hired a new RN who is also a RNY post-op and is being very critical of how we run our program. She states that she would not have gone through our program because we have our patients jump through too many hoops. The program where she had her surgery did not have her do anything pre-op and she only saw a RD 1x. Granted, she has lost a lot of weight and looks great, she has an atrocious diet. I would not want our patients to see what she eats!We require a 5% wl prior to scheduling a surgery date. Usually our patients can do this while waiting for insurance approval. After the weight loss is achieved, insurance is approved and a surgery date is set, we start a VLCD for 2 weeks. We have been doing it this way for 2 years with very good results, yet not a lot of numbers, obviously. Only between 60-70 surgeries (RNY and AGB). We pride ourselves on being a strict comprehensive program and our post-ops all agree that they are glad they learned how to take care of themselves before surgery. In fact, I tell my patients that "you can't perform a play or win a game without practicing." I have our patients "practice" like they have a pouch and only eat foods that they will be able to tolerate after surgery. Usually, eating that way provides a 5% weight loss very quickly. I also have them weigh-in at our office every 2 weeks and bring food journals, which I review and chart on. Our surgeon relies heavily on my report of how well a patient is doing with my diet protocols.I really would like to know other RD's view on this. Is this being too strict? I know that there is no sound research that states a WL prior to surgery is an indication of post-op success. I just can't believe that it would not help.I would appreciate any opinions.Thanks. , RD, CD Sneak preview the all-new .com. It's not radically different. Just radically better. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 23, 2006 Report Share Posted May 23, 2006 I don't think you are being to strict-I think it is great for long-term success! >From: Sandi Birch <foodycoach@...> >Reply- > >Subject: Re: WL before surgery >Date: Tue, 23 May 2006 11:14:22 -0700 (PDT) > >Hi , > I was very interested to read about your program. We, too, set up our >program with lots of pre-op time to prepare for long term success. I have >contracts that the patients sign at each visit with me. The first contract >states that we expect 3% wt loss before surgery. Patients often become >discouraged when they see that and state that they won't be able to do it >since they can't lose weight. However, if I can get them past that initial >reluctance they almost always surpass the expected 3%. And, as they do, >they gain confidence in their ability to lose weight, one of the most >important indicators of long-term success in my opinion. We have recently >added to our regular 3 monthly pre-op nutrition education visits a 2-4 week >VLCD. We see rapid wt loss during this phase. > Of course, we too meet with resistance from staff members who feel that >it is more important to increase volume and the best way to do so is to >expedite the time required before surgery. I am afraid that will be the >way of the future as pressure to meet volume to qualify to become a COE >increases. > Nice to hear from someone else in the same boat. > Sandi Birch, RD LD > EIRMC, New U Program > Idaho Falls, ID > foodycoach@... > >julielewrd <jlewis@...> wrote: > Do any other bariatric centers require a specific weight loss, like >5% BW prior to surgery? Very curious to find out. The main reason is >we just hired a new RN who is also a RNY post-op and is being very >critical of how we run our program. She states that she would not >have gone through our program because we have our patients jump >through too many hoops. The program where she had her surgery did >not have her do anything pre-op and she only saw a RD 1x. Granted, >she has lost a lot of weight and looks great, she has an atrocious >diet. I would not want our patients to see what she eats! > >We require a 5% wl prior to scheduling a surgery date. Usually our >patients can do this while waiting for insurance approval. After the >weight loss is achieved, insurance is approved and a surgery date is >set, we start a VLCD for 2 weeks. > >We have been doing it this way for 2 years with very good results, >yet not a lot of numbers, obviously. Only between 60-70 surgeries >(RNY and AGB). We pride ourselves on being a strict comprehensive >program and our post-ops all agree that they are glad they learned >how to take care of themselves before surgery. In fact, I tell my >patients that " you can't perform a play or win a game without >practicing. " I have our patients " practice " like they have a pouch >and only eat foods that they will be able to tolerate after surgery. >Usually, eating that way provides a 5% weight loss very quickly. I >also have them weigh-in at our office every 2 weeks and bring food >journals, which I review and chart on. Our surgeon relies heavily on >my report of how well a patient is doing with my diet protocols. > >I really would like to know other RD's view on this. Is this being >too strict? I know that there is no sound research that states a WL >prior to surgery is an indication of post-op success. I just can't >believe that it would not help. > >I would appreciate any opinions. >Thanks. > > , RD, CD > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2006 Report Share Posted May 24, 2006 It sounds to me that she is taking the protocols personally against herself since she is non compliant with the post op lifestyle which would explain her reaction. If that meant that she wouldn't have chosen your program because you go the extra mile to make sure they understand what they are gettting into, than it must be a good way to weed out people who would be non compliant and I wouldn't give it another thought for that reason. We do not require pre-op weight loss but that is the surgeons preference. J. Sams MS RD/LD >From: " julielewrd " <jlewis@...> >Reply- > >Subject: WL before surgery >Date: Tue, 23 May 2006 17:53:54 -0000 > >Do any other bariatric centers require a specific weight loss, like >5% BW prior to surgery? Very curious to find out. The main reason is >we just hired a new RN who is also a RNY post-op and is being very >critical of how we run our program. She states that she would not >have gone through our program because we have our patients jump >through too many hoops. The program where she had her surgery did >not have her do anything pre-op and she only saw a RD 1x. Granted, >she has lost a lot of weight and looks great, she has an atrocious >diet. I would not want our patients to see what she eats! > >We require a 5% wl prior to scheduling a surgery date. Usually our >patients can do this while waiting for insurance approval. After the >weight loss is achieved, insurance is approved and a surgery date is >set, we start a VLCD for 2 weeks. > >We have been doing it this way for 2 years with very good results, >yet not a lot of numbers, obviously. Only between 60-70 surgeries >(RNY and AGB). We pride ourselves on being a strict comprehensive >program and our post-ops all agree that they are glad they learned >how to take care of themselves before surgery. In fact, I tell my >patients that " you can't perform a play or win a game without >practicing. " I have our patients " practice " like they have a pouch >and only eat foods that they will be able to tolerate after surgery. >Usually, eating that way provides a 5% weight loss very quickly. I >also have them weigh-in at our office every 2 weeks and bring food >journals, which I review and chart on. Our surgeon relies heavily on >my report of how well a patient is doing with my diet protocols. > >I really would like to know other RD's view on this. Is this being >too strict? I know that there is no sound research that states a WL >prior to surgery is an indication of post-op success. I just can't >believe that it would not help. > >I would appreciate any opinions. >Thanks. > > , RD, CD > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 24, 2006 Report Share Posted May 24, 2006 Hi - Our program is strict like yours...with good results (and low volume still). We do not require weight loss before surgery, but we do require at least 6 "classes" with the dietitian prior to surgery. (We require weight loss for some pts depending on their insurance requirements.) I also collect food journals weekly. We have them do a 3 week VLCD, and have cancelled surgeries when pts are not adhering to the diet. (We see them weekly for this 3 weeks prior to sx to check their weight and review the diet/lifestyle changes that are required after surgery.) Our theory is that non-compliance before surgery will lead to non-compliance after surgery, our RN/manager, surgeons, and internist are all very supportive of our guidelines. I am very proud to work for a program that has strict guidelines AND good outcomes! Keep up the good work! Sams <jenniferjsams@...> wrote: It sounds to me that she is taking the protocols personally against herself since she is non compliant with the post op lifestyle which would explain her reaction. If that meant that she wouldn't have chosen your program because you go the extra mile to make sure they understand what they are gettting into, than it must be a good way to weed out people who would be non compliant and I wouldn't give it another thought for that reason. We do not require pre-op weight loss but that is the surgeons preference. J. Sams MS RD/LD>From: "julielewrd" <jlewis@...>>Reply- >To: >Subject: WL before surgery>Date: Tue, 23 May 2006 17:53:54 -0000>>Do any other bariatric centers require a specific weight loss, like>5% BW prior to surgery? Very curious to find out. The main reason is>we just hired a new RN who is also a RNY post-op and is being very>critical of how we run our program. She states that she would not>have gone through our program because we have our patients jump>through too many hoops. The program where she had her surgery did>not have her do anything pre-op and she only saw a RD 1x. Granted,>she has lost a lot of weight and looks great, she has an atrocious>diet. I would not want our patients to see what she eats!>>We require a 5% wl prior to scheduling a surgery date. Usually our>patients can do this while waiting for insurance approval. After the>weight loss is achieved, insurance is approved and a surgery date is>set, we start a VLCD for 2 weeks.>>We have been doing it this way for 2 years with very good results,>yet not a lot of numbers, obviously. Only between 60-70 surgeries>(RNY and AGB). We pride ourselves on being a strict comprehensive>program and our post-ops all agree that they are glad they learned>how to take care of themselves before surgery. In fact, I tell my>patients that "you can't perform a play or win a game without>practicing." I have our patients "practice" like they have a pouch>and only eat foods that they will be able to tolerate after surgery.>Usually, eating that way provides a 5% weight loss very quickly. I>also have them weigh-in at our office every 2 weeks and bring food>journals, which I review and chart on. Our surgeon relies heavily on>my report of how well a patient is doing with my diet protocols.>>I really would like to know other RD's view on this. Is this being>too strict? I know that there is no sound research that states a WL>prior to surgery is an indication of post-op success. I just can't>believe that it would not help.>>I would appreciate any opinions.>Thanks.>> , RD, CD>>>>__________________________________________________ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted May 25, 2006 Report Share Posted May 25, 2006 Dear all, Why do you advice modest weight loss before surgery? Do you have some evidence of that? Does it has any especifical advantages in terms of complications, hospital stay lenghts, greather long term weight loss, etc.... Probably you can help me to learn more. Thank you! ______________________________________________ LLama Gratis a cualquier PC del Mundo. Llamadas a fijos y móviles desde 1 céntimo por minuto. http://es.voice. Quote Link to comment Share on other sites More sharing options...
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