Explaining expected recovery and follow up benchmarks and complications (i.e.
depression …)
Requesting a letter of support from the patient's local primary care physician
including:
I. Assessment of the patient's health
status ( a routine complete history and physical examination:) Assessing
patient’s medical, surgical and psychological fitness to undergo major abdominal
surgery
II. An assessment of the patient's obesity
and competency to understand the risks and choose to go forward with surgery.
III. Documentation of the physician's
willingness of the physician to participate with Dr Rutledge and CLOS to care
for the patient followig surgery
Dear Dr.,
Your patient has contacted me in reference to being considered for Bariatric
surgery for a
laparoscopic "Mini-Gastric Bypass."
Request for a Letter of Support:
By copy of this letter I would like to ask for your advice, direction and support in considering the patient's request for bariatric surgery.
Specifically I would like to request that you consider forwarding me a letter about your patient. If you agree I would like to request a letter from the primary medical physician to assist me in three parts of my evaluation of the patient’s obesity and their candidacy for surgery.
First, I would like to request a well documented routine through detailed history and physical examination to assist in determining the patients potential surgical risks as well as potential benefits of major weight loss. I would like to ask for you to consider the patient’s obesity and its impact on his or her health and quality of life. I ask for your assessment of the patient’s medical, surgical and psychological fitness to undergo major abdominal surgery (essentially a history and physical examination).
Secondly I would ask for you to consider the patient's metal competency to face a decision of this magnitude and their ability in your opinion to follow a physician's instructions for life time follow up and maintenance of a prescribed supplement regimen.
Finally I request that the patient’s physician state his or her willingness to follow the patient in concert with me over the long term. This is especially important for encouraging the patient to remain in contact with healthcare providers to continue his or her multivitamin regimen (3 standard multivitamin tablets per day) and for yearly monitoring for vitamin and mineral levels to identify and treat potential deficiencies.
I ask that you consider providing this letter directly to the patient, as it must
be included as part of the very extensive application package I require for the
patient to create in preparation for surgery. In addition to your letter the
patient must provide us with copies of his or her pertinent past medical
records, a complete history and physical with the results of a recent CBC,
Electrolytes and EKG, a letter of support and understanding of the risks and
benefits of surgery from the patient’s family, full length front and side
photographs, contact with at minimum 10 of my previous patients who have
undergone this surgery and a 10 page letter written by the patient demonstrating
knowledge of:
1. Understanding the Risks of Obesity
2. Understanding Morbid \ Clinically Severe Obesity
3. Understanding Why the Operation is performed
4. Understanding How the Operation is performed
5. Understanding the Expected Benefits of Surgery
6. Understanding the Expected Risks of Surgery
7. Understanding the Risks of Gastritis, Ulcers and Bile Reflux
8. Understanding what to take for Pain and Colds
9. Understanding of the Alternatives to Surgery
10. Understanding the Post Operative Diet Changes
11. Understanding the Risks of Alcohol, Acetaminophen and Liver Disease
12. Understanding the Possible Depression After Operation
13. Understanding When to Use the Estrogen Patch in Women
14. Understanding the Need for Long Term Follow Up
15. Understanding the H. Pylori, the Billroth II and the risks of stomach
ulcers, gastritis and stomach Cancer
All of this information is to be put together into a package that is presented to me to be reviewed prior to operation. I have as of performed over 3,901 laparoscopic Mini-Gastric Bypasses. Over the 9 years that I have been performing this surgery we have had overall excellent results. The operative procedure takes an average of 38 minutes in previously unoperated patients and the hospital stay is 1 day in over 95% of patients.
The mean weight loss is 140 lbs at one year and we have has greater than 90% success in reversing diabetes, sleep apnea, hypertension etc. We have operated upon patients from all 50 states across the U.S. including Alaska and Florida, as well as Canada, England, Japan, Puerto Rico and Iceland. For any further information please call
The Center for Laparoscopic Obesity Surgery, Email: DrR@clos.net. Also please
consider visiting our website at http://clos.net/
Your help in the preoperative evaluation of this patient is greatly
appreciated.
Sincerely,
Robert Rutledge, M.D., F.A.C.S.
The Center for Laparoscopic Obesity Surgery