MGB Application Packet Steps: What do you have to do?

The steps required to undergo the MGB surgery are detailed below:

1.       Read Selection Guidelines

2.       Join Mailing List

3.       Send in Patient Information

4.       Complete Patient Education (=Read the Manual)

5.       Get Support Letter and Exam from Your Referring Doctor

6.       Write Your Patient Letter

7.       Get Psychological Evaluation

8.       Contact 10 Previous Patients

9.       Photographs

10.    Have Your Family Write a Detailed Support Letter

11.    Preoperative Clinic Visit

12.    Read and Complete Consent Form

1. Read Selection Guidelines

The goal of this section is to try to help you understand who is a good candidate for the laparoscopic weight loss surgery, and why our standards are important to assist us in getting a successful outcome. 

These guidelines are not “cookbook” medicine, that is, they are designed help to guide us advising you and not dictate patient selection of the patients for surgery.  We review each individual patient’s case and patient selection is not rigid but directed by the following guidelines.

Review and understand the selection guidelines for the Mini-Gastric Bypass.

2. Join Mailing List

As part of your preoperative education and investigation process you are required to join our internet online email mailing list.  The MGB mailing list on the internet hosted at Yahoo.com will enable you to learn from other patients’ experiences, and give you additional support in your own journey.  You can be added to the online mailing list by filling out the form on our web site:  http://health.groups.yahoo.com/group/Mini-Gastric-Bypass/

3. Send in Your Patient Information

As part of your process of being evaluated for the surgery we need to review your medical information.  We ask that you carefully complete our online information form.  This will allow us to review your medical information.  The internet form is located at on the web at http://clos.net/patinfo.htm. Note: Please fill this form out completely and carefully.  Take your time to do it all it once, as the form is lengthy.  It must be filled out with phone numbers and addresses.  A good idea is to print out the form, fill it in by hand, then type in all the information in later.

Tips for Completing the Online Patient Information Form

·          Before you start: Print out a copy of the blank form and read it carefully.

·          Collect all of the information needed to complete the form before you start (insurance information, medication spelling and doses, doctor’s address phone and fax etc.) prior to filling out the form.

·          Fill out the form on paper before trying to fill out the form online.

·          If you are new to the Internet get help filling out this form from someone who knows how to use the computer and the internet.

·          Make sure that you have just signed on to the Internet before you start filling out the form some internet companies will close your connection if you wait to long.

·          After you have sent in (submitted) the form on the internet make sure that you get a confirmation page.

·          Print out the confirmation page and then use the back button on your browser and print out two copies of the form, one to keep and one to take with you to clinic.

4. Complete Your Preoperative Patient Education (=Read the Manual)

As part of completing your packet for surgery approval, you will need to write a detailed letter explaining the process, the surgery, alternatives to surgery, possible surgery complications, risks of obesity, compliance issues, etc.  This letter is mandatory, and demonstrates your ability to comprehend the material.  It is an indication of your ability to comply with the life changes you will need to make in order to have the most successful outcome.   Our physicians will reject packets that contain letters that do not address each aspect of the process thoroughly.  You must include a plan for physical exercise in this letter. 

We require a Special Consent Form for Surgery that gives a summary of the surgery and its risks and complications, the cost of the surgery in relation to other weight-reduction surgeries, and other alternative treatments.  Please complete this form and bring with you the day of surgery. Please don’t sign the last page until you are at the hospital and in the presence of a nurse.

5. Support Letter and Exam from Your Medical Doctor

A variety of early, medium and long-term complications, problems and illnesses can cause difficulties after the operation. Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity Surgery are committed to provide long-term follow up for all of his patients after Laparoscopic Gastric Bypass. But, since many patients are from hundreds and even thousands of miles away, it is imperative that patients develop a close relationship with a local medical physician who has the interest and the knowledge to follow patients with Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity Surgery and care for them through out the years after surgery. An interested and committed local physician is also critically important in providing additional assistance in the preoperative evaluation of patients prior to surgery. In addition, our experience has demonstrated that patients are often difficult to contact after operation. In several cases it was a contact with a local physician that allowed us to find our patient and determine how they are doing. This is crucially important given the long-term risks of the gastric bypass as it relates to vitamin and mineral deficiencies. For all of these reasons we require the following process in the preoperative assessment and preparation of patients for Laparoscopic Gastric Bypass:

The patient must obtain a letter from his or her local medical physician. 

The letter must include 

·          An assessment of your obesity and its impact on you health and quality of life,

·          A detailed thorough and meticulous assessment by your Dr. of your medical, surgical and psychological fitness for surgery, and

·          Demonstrate your Dr’s willingness to follow you after surgery. 

·          All patients are required to have a close working relationship of at least several months with a local physician.

·          The physician must support the patient’s desire to proceed with Mini-Bypass.

·          The physician must perform a thorough detailed complete history and physical evaluation as a preoperative screening step prior to considering patient for Laparoscopic Gastric Bypass. This should be included in your packet and be typed usually a minimum of one page in length. Scribbled unreadable faxes and check box forms are not acceptable.

·          The patient must obtain a letter of support and the medical records from their physician and the preoperative history and physical examination for review prior to proceeding with surgery.

·          The letter must include an assessment of your obesity, its impact on your health and quality of life, an assessment by your Doctor of your medical, surgical and psychological fitness for surgery, and the Doctor’s willingness to commit to follow up with you at 1 month, 3 months, 6 months and 12 months post-op.  Please give a copy of the patient education manual to your Doctor.  This will assist him in understanding the long-term implications of this surgery, and educate him for the best possible working relationship.

Other Medical/Health problems

If you have other Medical or Health problems you will need to see each of those specialists for their assessment and advice about how your medical and health issues might affect your candidacy for surgery, your risk of surgery and your long term results of surgery. Please ask each of your medical specialists to send Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity Surgery a detailed letter describing your special medical or health issues that that particular Doctor is taking care of you for, ask him or her to comment upon how this illness might affect your candidacy for the surgery, your risk of surgery and how it might affect your long-term results after the surgery. Does he/she approve or recommend the surgery in your case? Does he/she support your having the surgery?  Please ask that your specialist advise Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity Surgery of any special precautions, pre/post-op recommendations for your care.  This might include special use of medications or additional consultations or tests.

6. Patient Letter

One of the most important efforts of the preoperative preparation of patients for the Laparoscopic Gastric Bypass is an education about the risks and benefits of the operation. When we surveyed patients about our efforts to educate them about Laparoscopic Gastric Bypass surgery, we received a high level of approval.

It’s extremely important that you understand the surgery before you undergo it... as well as your alternatives. If you have to rethink the surgery, its potential complication and its alternatives once or twice... that’s not so bad, as the surgery you are undertaking is life changing and potentially life threatening (as is any surgery). Sure, you’ve thought about it a million times in your mind, but writing it out... that takes a bit more thought. My advice as to writing... pretend you are talking to your best friend... assume s/he is asking you the questions... make your letter your answer to your friend.

The letter requirement is based upon educational research showing that retention of information is improved by asking the learner to think about and write down the information. Patients who are not able to understand enough to write a letter detailing the risks and benefits of the operation will be poor candidates for Laparoscopic Gastric Bypass.

Options: 1. Written Letter vs. 2. Online Patient Letter Form

We have now added an online option to complete the patient letter.  You now have two options to complete the patient letter requirement of the preoperative patient preparation.  You can complete this requirement by typing the letter as described below or by completing the online form on the web. http://clos.net/pat-letter.htm

Online Patient Letter Form

http://clos.net/pat-letter.htm

You can now complete the patient letter requirements by completing the online form found at http://clos.net/pat-letter.htm The online form must be competed in detail to fulfill this requirement.

Written Patient Letter Contents

The patient is asked to write a typed letter addressing each of the fifteen topics. The patient is asked to write one typed page on each topic. Hand written letters are not acceptable. The typeface to be used 12 point and the line should be 1 to 1 and ½ space on each page.

·          Understanding the Risks of Obesity

·          Understanding Morbid \ Clinically Severe Obesity

·          Understanding Why the Operation is performed

·          Understanding How the Operation is performed

·          Understanding the Hoped for Benefits of Surgery

·          Understanding the Risks of Surgery

·          Understanding the Risks of Gastritis, Ulcers and Bile Reflux

·          Understanding what to take for Pain and Colds

·          Understanding of the Alternatives to Surgery

·          Understanding the Post Operative Diet Changes

·          Understanding the Risks of Alcohol, Acetaminophen and Liver Disease

·          Understanding the Possible Depression after Operation

·          Understanding When to Use the Estrogen Patch in Women

·          Understanding the Need for Long Term Follow Up

·          Understanding the H. Pylori, the Billroth II and the risks of stomach ulcers, gastritis and stomach Cancer

7. Psychological Evaluation

All our patients undergo a psychiatric evaluation to assess their psychological status prior to the Gastric Bypass. It is a requirement for a patient to see a psychologist or psychiatrist in preparation for the surgery. The psychiatric evaluation in preparation for surgery is recommended.

·          An evaluation by your usual medical doctor will not fulfill these criteria.

·          Either a psychologist or a psychiatrist can perform it. A social worker or other therapist is not an acceptable choice.

·          The patient should have a routine psychiatric evaluation to rule out significant eating disorders or other major psychiatric illnesses that may affect the results of surgery.

·          Patients with inadequately treated depression need to be appropriately diagnosed and treated prior to surgery. Alcohol and drug abuse are also relative contraindications to surgery. The patient must not have unrealistic expectations of the outcome of surgery.

Guideline for Psychiatric Evaluation

Purpose of Evaluation

The psychiatric evaluation includes a face-to-face interview with the patient. A general evaluation usually takes no more than 1 hour to complete. Several meetings with the patient should not be necessary.

The psychiatric consultation is requested for the purpose of assisting in the diagnosis, treatment, or management of a patient’s possible mental disorder or behavioral problem.

The aim of the psychiatric evaluation is to provide answers to the questions including:

·          Patient’s competency in deciding to proceed with gastric bypass. Is the patient competent to decide to proceed with surgery?

·          History of Substance Use. Does the patient have a past history of drug or alcohol use, abuse or dependence? If so what role might this play in the future of this patient given the expected stress that occurs in the postoperative period?

·          The presence of any Psychiatric diagnosis relevant to the gastric bypass; in particular is the patient psychotic? If any form of psychiatric illness is identified then prognosis and treatment advice should be included.

·          Willingness of the psychologist/psychiatrist to follow and treat the patient in the postoperative period. In addition the letter should include a commitment to be available for consultation in the event that depression occurs in the postoperative period.

·          Patient’s ability to handle the stress of the period that follows surgery

·          The evaluation should respect the patient’s relationship with the primary clinician and should encourage positive resolution of conflicts between the patient and the primary clinician if these emerge as an issue.

·          Issues to be addressed in the Psychiatric Evaluation: History of the Present Illness, Past Psychiatric History, General Medical History, History of Substance Use, Social History, Occupational History, Family History, Review of Systems, Mental Status Examination, Functional Assessment, Information Derived from the Interview Process.

8. Contact with Preoperative Patients

We require that all preoperative patients spend time talking with patients that have already undergone surgery Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity.  To meet this requirement you have to contact at least 10 previous patients as part of your application package.  You must also fill out the online patient contacts form.  It is located on the Internet at: http://clos.net/forms/patient_contacts_form.htm

For each of your patient contacts please type the patient’s first and last name, the method of contact, the patient’s email address, the patient’s date of operation, the patient’s preoperative weight, the patient’s weight now, the date of contact and 1-2 paragraphs of written information about the contact demonstrating that the contact was made. 

Ask questions such as:

·          What did you think about Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity Surgery?

·          What did you think about Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity Surgery’s staff?

·          What did you think about the Hospital?

·          How was your experience with the surgery?

·          How much pain did you have?

·          When did you go back to work?

·          How much weight did you lose?

·          Would you do it again?

·         Get the list of volunteer post op patients from Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity Surgery.  When you have contacted all of your 10 patients, fill out the ONLINE PATIENT CONTACTS FORM.  Print a copy before you submit it.  Submit it online.

·         You should include a printed copy of this online form in your packet.

9. Photographs

These pictures will be used to document your physical size and appearance both before and after surgery.  They will be viewed by our physicians in assessing your physical makeup, and may be used in the future to assist you in grasping the physical changes your body has undergone post surgery.  We recommend a bathing suit photo, but if you are not comfortable with that, exercise clothes that fit closely to your body would be appropriate.  We need to see the shape and size of your stomach and abdominal area. Note: All photos should show you clothed, Do not send photos without clothing please!

10. Family Letter

The family support letter is vital in documenting that your family knows and understands why you seek this surgery, the changes you will undergo, and the emotional and physical changes that affect you and them.  This letter should also explain their understanding of the possible risks as well as benefits of a surgical weight loss option.  This letter can allow your family to express their concerns about you, and the state of your health.  One of the factors that have been identified from our patient survey is the importance of the family in successfully coping with the stresses that occur in the postoperative period. Patients that live alone and / or are far from their family members appear to have more problems than those with close supportive families. Because of these findings, we are changing our methods for preoperative evaluation as well as the processing of patients prior to consideration for surgery. Some of our main goals include an assessment of the patient’s family structure and education of family members about the patient’s interest in the gastric bypass. This will require that the spouse, parent, brother, sister or adult children accompany the patient to at least one (ideally all) of the clinic visits. This changes our past policy and is designed to improve the quality of care provided to our patients. The family must also be able to learn about and understand the educational issues related to the laparoscopic gastric bypass.

·          Patients must provide a detailed description of their family and family support structure.

·          Family member(s) or a friend must accompany the patient to the educational preoperative visits.

·          Family members must have an equal understanding of the issues related to selection of the Laparoscopic Gastric Bypass.

·          The Patient will choose a family support member to write their letter.  If the patient is married the spouse must submit a family letter.

·          It must also be signed and notarized when submitted in the packet.

11. Clinic Visit

To make an appointment go to http://clos.net/forms/clinic_appointment_form.htm or please call 704-871-0031, 704-682-1226 or  to schedule a time to attend and to ask any questions you may have.  You may also email us at DrR@clos.net  with questions and concerns.

·          Before coming to clinic you may want to have completed your history and physical examination with your Doctor.

·          Clinics are on Tuesdays.  Please call in advance if you plan to attend.

·          When you pre-register, you will be weighed & your waist measured.

·          Clinic is 3 or more hours long.

·          Please wear loose fitting two-piece outfits at both Clinics so that Dr. Rutledge and the Surgeons of the Centers for Laparoscopic Obesity Surgery can easily examine you prior to surgery and post-op for easier removal of staples.  Please do not wear panty hose or other garments that will hinder your physical examination. 

·          You will return to the Post-operative Clinic the following week for your staple removal and final checkup.

12. Consent Form

We want to assure you and your current and future healthcare providers that we are concerned with the privacy of any health-related information that you or your providers supply to us.  We take all necessary precautions to protect the privacy and integrity of your health information, including obtaining your consent and permission that will allow your healthcare providers to share health information about you with us.  Please complete the following three forms and include them with the written materials that you provide to us:

Give Consent for Release of Protected Health Information. 

This will allow your primary care physician to keep us updated with your progress after you return to his or her care.

Give Permission to Use Photographs and Personal Statements. 

We want you to celebrate your success!  With your permission, we may want publish your “before and after” photographs as a testimonial to your success with laparoscopic gastric bypass surgery.  If you have a personal story or statement that you would like to share, we would also ask for your permission to publish that statement and give you credit for it. 

What’s Next

After these steps are completed, you can be scheduled for surgery on the next available date.  There is no additional waiting period once you have been approved for surgery.

This notice describes how information about you may be used and disclosed and how you can gain access to this information.  Please review carefully

Contact Information: -Telephones: *** CLOS West: 702-456-4643; Trish Lanman 702-376-3446, Sandy Brubaker 702-376-3647; Jennifer Brubaker 702-376-9339, Dr. Rutledge 702-215-9550; 989-450-8081 Kim Hazen 989-450-8081 *** CLOS Florida: Flo Ballengee 863-899-3463 Wayne Robbins 704-682-1549 Elizabeth Robbins 704-928-6693 Dr. Cesare Peraglie 407-922-3424

Email Us Anytime for Help: Email: Dr. Rutledge DrR@clos.net, *** CLOS West: Trish Lanman Trish@clos.net, Sandy Brubaker SandyB@clos.net Dr. Rutledge DrR@clos.net, Kim Hazen khazen@clos.net *** CLOS Florida: Flo Ballengee flo@clos.net, Wayne Robbins wr@clos.net Elizabeth Robbins epr@clos.net Dr. Peraglie drp@clos.net

Addresses: Address: *** CLOS West Office: Dr Robert Rutledge / CELOS, 98 E Lake Mead Parkway Suite 302, Henderson NV 89015, Office 702-456-4643, Office fax: 702-456-1173, Contacts: Trish Lanman 702-376-3446 Trish@clos.net, Sandy Brubaker 702-376-3647 SandyB@clos.net, Jennifer Brubaker 702-376-9339 Jen@clos.net, Dr. Rutledge 702-215-9550 Drr@clos.net Kim Hazen 989-450-8081 khazen@clos.net *** CLOS Florida: 40124 Highway 27, Suite 203, Davenport, FL 33837, Wayne Robbins 704-682-1549, wr@clos.net, Elizabeth Robbins 704-928-6693 epr@clos.net, Dr. Peraglie 407-922-3424 drp@clos.net

Warning: Gastric Bypass Surgery is a MAJOR surgical procedure. It can be associated with significant risks and complications, up to and including death. Weight loss surgery is a rapidly developing area of medicine. Bariatric surgery is filled with controversy. It is very important to take a careful and deliberate approach to considering surgery for the treatment of obesity.  

Disclaimer Notice:-Information on this web site is provided for informational purposes only.
-It is imperative that you consult your own physician regarding the applicability of any opinions or recommendations with respect to your symptoms or medical condition.
-Contact with this web site or Dr. Rutledge over the web site does not constitute a doctor patient relationship and for good quality medical care you must obtain advice and consultation form your own local physician.
-This site is intended as a resource for references on the treatment of obesity for health care professionals and educated consumers.
-The authors and editors have used sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication.
-Medical knowledge changes rapidly. In view of the possibility of human error or changes in medical science, neither the authors nor the editors nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they are not responsible for any errors or omissions or for the results obtained from the use of such information.
This information is not medical advice or diagnosis, nor is it to be construed as medical advice, medical information, medical diagnosis, or medical prescription for curing, removing, or preventing any disease, or related symptoms. You must seek the direct assistance, advice and evaluation of your own personal physician before acting on any information found herein. These statements have not been evaluated by the Food and Drug Administration.
-Readers are Strongly encouraged to discuss and confirm the information contained herein with your own physician.
Copyright © 1998 The Center for Laparoscopic Obesity Surgery