1	Weighing Your Options Presented by Maine Medical Center Bariatric Program
2	Multidisciplinary Team Surgeons – Roy Cobean Renee Wolff Dietitians – Barbara Corriveau, Deb Dumoulin, Sara Northrup Therapists – Laura Hauser, Ashley French Program Nurses – Sharon Lepich, Deb Dumoulin
3	Confidentiality We respect a patient’s right to privacy, and ask that you do the same. If you see someone you know at the clinic or at support group, kindly keep this information to yourself. Many people do not tell their extended family and friends about their interest in this program.
4	NIH Consensus Conference 1991 Surgery is an accepted and effective approach that provides consistent, permanent weight loss for morbidly obese patients Surgery indicated in patients with: BMI of 40 or over BMI of 35-40 with significant co-morbidity documented dietary attempts ineffective
5	Using the Body Mass Index (BMI)
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7	Conventional Therapies Diet Exercise Behavior Modification Weight-Loss drugs 10% weight loss
8	Insurance Ask for your policy for specifics Some insurance require special riders in order to even cover the procedure All will pay for the evaluation but not necessarily the surgery Some insurances have requirements above and beyond what we normally do We pre-approve at the completion of the program.
9	Program Steps Step 1 Information Gathering Primary Care Doctor Referral letter…Medical neccesity medical information information session Stopping Tobacco Use Step 2 Team assessments Initial Assessments with Surgeon, Therapist and Dietitian Support Group
10	Program Steps Step Three Tasks Medical tests Personal Task List Approval from Therapist and Dietitian, Nutrition quiz
11	Program Steps Step 4 Ready for Surgery Sign consent Chart to CBS Insurance approval Possible Nurse visit Pre-op Anesthesiologist visit Pre-op Diet Day of surgery Hospitalization Getting in the required amount of liquids
12	Program Steps Step 5 First 90 days post-op Early focus on drinking 64 ozs of fluid per day Preventing constipation Taking your pulse Adding in Protein requirements Soft/blended diet for one month Acid suppression for one month first visit 4-6 weeks after surgery Second visit 6-8 weeks later
13	Program Steps Step 6 Long term Follow up Support group Visits at the Bariatric Center with Dietitian 6 months 12 months 18 months 24 months Annually forever Adjustment visits You need to get a separate referral for these later post-op visits from your Primary Care Doctor for insurance coverage. Some may not be a covered service.
14	Requirements Before Surgery PCP written letter of medical necessity Medical Information Stop all tobacco use, get nicotine level done Attendance at information session Insurance coverage confirmed, requirements met Assessments and approval from dietitian, Therapist and Surgeon All tasks completed Support group attendance Surgeon meets Support person and or next of kin Surgeon Class attendance Ultrasound, birth control if applicable
15	Surgical Options
16	The LAP-BAND System Lowest mortality and complication rate Least invasive surgical approach No stapling, cutting, or intestinal re-routing Adjustable Reversible Low malnutrition risk Slower initial weight loss than Gastric Bypass Regular follow-up critical for optimal results Requires implanted medical device
17	Possible Risks and Complications Remember: There are risks associated with any surgery.
18	Comparing Weight-Loss Results
19	Your Decision
20	Resources Read your Handbook www.lap-band.com www.bariatricedge.com Keep all information together for your reference Call 396-5688 if you have any questions