| Dear Doctor, I want to first take this opportunity to thank you for allowing me and the entire bariatric team at GBMC to help you and your patients deal with the problem of obesity. Our program has developed over the last one and one-half years to become a more comprehensive or multidisciplinary resource for management of obese patients. However, there are certainly improvements that can be made to make the program more responsive to your needs and, certainly your patient’s needs.
I have been made aware of the issue regarding preoperative examinations and lab studies. We do require patients to come to our office several weeks prior to surgery for a one-day seminar or educational session regarding diet and nutrition, exercise therapy, psychosocial issues, and preparation for surgery. However, we would be happy to have you, the primary physician, perform the preoperative physical exam and usual lab studies: CBC, CMP, and EKG. We would only ask that you fax to us the exam and results of studies at least one week prior to surgery date. The EKG needs to have a physician’s written interpretation and not just the computer-generated interpretation.
We have decided to drop the requirement for a mandatory echocardiogram on all patients. However, patients who have taken Phen-Fen in the past, as well as those with cardiovascular disease, will still need a preoperative echocardiogram. We will still require some patients to receive a full cardiac evaluation: patients with a history of angina or coronary disease; patients with a history of CHF or possible pulmonary hypertension, cor pulmonale; patients with severe hypertension on multiple antihypertensives; and any patient with other significant cardiovascular disease.
Our policy in the past was to obtain sleep studies on all patients, but these tests are cumbersome and difficult for our patients. Although it is good to document the prevalence of obstructive sleep apnea in obese patients, we will only order sleep studies for patients with symptoms suggesting moderate or severe sleep apnea, likely to require CPAP or BIPAP. Pulmonary Function Tests document obstructive and restrictive patterns in our patients. Those with significant obstructive disease may benefit from bronchodilator therapy, etc. pre-op. Severely abnormal PFT’s and ABG’s will select patients who may require home oxygen therapy, bronchodilators, postoperative ICU monitoring, and as a baseline for postoperative monitoring. Therefore, we will still require all patients to obtain PFT’s and ABG’s.
We obtain a preoperative UGI series to evaluate normal anatomy and presence of disease since noninvasive evaluation of the distal stomach and duodenum postoperatively (after gastic bypass) is impossible. An ultrasound is obtained to evaluate for cholelithiasis and liver size and abnormalities. Cholecystectomy is performed with the bariatric surgery for patients with gallstones and/or symptoms of biliary tract disease. Liver biopsies (tru-cut needle) are performed in patients with abnormal transaminases or evidence of cirrhosis. We also obtain a number of hematology and chemistry studies important for pre- and post-op management of patients.
I hope this is information that will be useful for you in managing obese patients and interacting with our program. If you have other questions or want to speak with me or the bariatric program coordinator, our contact info. is: main office-443 849-3779. In closing, I want to let you know that our program was recently designated as a Center of Excellence by the American Society for Bariatric Surgery, our governing body. Thank you. Sincerely, Babak Moeinolmolki, M.D. |
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