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The Mini-Gastric Bypass Surgery |
 Short, Simple, Effective |
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Call Dr. Rutledge 702-714-0011 or Email: DrR@clos.net |
Call Dr. Peraglie 407-922-3424 or Email: DrP@clos.net |
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Our goal is to try to continuously improve our process of care in order to have the most successful immediate surgical experience and long-term success. There are both immediate and future ramifications to the surgical treatment of obesity. Our research has shown that by utilizing an extensive preparation process, our patients are better informed and better able to cope with and enjoy the changes that accompany substantial weight loss. The steps to prepare for surgery are as follows: Where to Start: Initial Patient ContactPatients may initially contact The Centers for Laparoscopic Obesity Surgery through a variety of people or methods including: Web, Email, Telephone, Letter, or Direct Face to Face. For each of these types of initial contacts the patient is referred to the new patient web page. New Patient Start up Web Page Web page: http://clos.net/newpt.htm Why our process is so complex:Our preoperative and postoperative processes are complex and demanding because: · We are committed to excellence in Pre and Post Education and quality patient care. · Help in the selection of the best patient candidates for laparoscopic surgical treatment · To help long distance and local patients get the best possible patient care · To systematize our medical care and therefore improve the quality of our outcomes Patient Comments about the CLOS “Packet”Flo from Maryland
6/27/01 highest weight 295 pre-surgery 270/now 170
MGB Application Packet: Submission Requirements & SuggestionsMGB Application Packet Check List:Dos and Don’ts on Sending in Your Packet· Please DO Make a Duplicate Copy of Everything in the Packet. Make a copy of everything in your packet before you send it. We cannot return copies of your packet after they have been submitted. · Please DO submit your packet as loose separate unbound 81/2 by 11 inch single sheets of letter-size paper in usual manila folder. · Please DO staple the individual sections together that are more than one page long. · Please DO NOT put the pages in separate plastic sheets. · Please DO NOT submit your packet bound in a notebook, or in a 3-ringed binder. · Please DO make sure that every part of the packet is neatly typed and readable
MGB Application Packet Steps: What do you have to do?The steps required to undergo the MGB surgery are detailed below:
Welcome from Dr. Rutledge and CLOS
Dear Future MGB/CLOS Patient,
We are also happy to announce New Pricing/New Procedures and a streamlined New Process for the preop evaluation of the MGB.
This "Notebook" is
designed to help you complete the "Preop Evaluation Packet" (the "packet" is the
collection of documents you send to us for review prior to approval for
surgery). The Notebook has two main sections. Section 1 explains the parts of the packet that you will need to complete. And the second section contains printable pages that act as dividers. You will print those pages then insert the required material behind the divider page.
In the left column below is an
explanation of the parts of the "Preop Evaluation Packet "("The Packet") and
second is a list of pages for you to print and put in the front of each part of
the packet to help you get the whole thing organized. The printable pages
act as dividers to divide each part of the packet you will submit. This notebook will help you to better understand the surgery and better prepare you for surgery by increasing your knowledege about obesity, obesity surgery, and the MGB and will enable us to take much better care of you when you come to have your surgery with us. Doing the packet is difficult and demanding but is designed to maximize your education and safety.
Organizing Your Packet to Submit
This is your Patient Packet notebook. If
you will follow the check list and helpful hints, you should have few problems
with preparation. You
will need to purchase dividers with tabs that can be labeled. Label each section
as directed. Place the documents or items called for in back of each divider.
Then place the completed packet in a folder. Please do NOT punch holes or staple
any of the contents. You may write on the check off list and the other forms
that are designated to write on. MGB Patient Packet Helpful Hints
Our Schedule Scheduling your surgery or coming to clinic to meet us? Check with us in advance. This schedule is regular, but is subject to change. Tuesday: 8:30 a.m. - Registration is held on the first floor conference room. Please check in with admitting in the front lobby, they will bring you to the conference room. 9:00 a.m. - Preoperative Clinic as well as staple removal from last week's surgical patients - Annex room of the hospital
Wednesdays and Thursdays: Surgery
days
Thank you. Some other things you’ll need to know: Be sure to check your email frequently and follow any instructions you receive.You will receive a call for hospital registration and nursing assessment prior to your arrival for surgery. You will have your staples out the Tuesday morning after a Wednesday or Thursday surgery. The day before your surgery you need to go to the St. Rose Delima Hospital, 102 E. Lake Mead Pkwy, Henderson, NV 89015 to register for surgery. You will pay the hospital portion at this time. The hospital will give you a receipt. You will pay the portion for Dr. Rutledge and Anesthesiology at the Tuesday morning preop clinic. Your receipts will be in your discharge instructions the day following your surgery. The email containing your surgery instructions will explain the distribution for the cashier’s checks Remember, if you live more than two hours away, you promise to remain in the area for seven days. Please contact any of our staff members should you have any questions. We’re here to assist. Sandy Brubaker, 702-376-3647, Email: sandyb@clos.net Jen Brubaker, 702-376-9339, Email: jen@clos.net Trish Lanman, 702-376-3446, Email: trish@clos.net Now let's start working on your packet!
There are 12 sections if the
Packet. Section 1: Read
the manual and complete the online form (Learn about the MGB and tell us
about you); Section 2: Dr's
History and Physical/ Lab tests etc. (PreOp Medical Evaluation); Section
3: Psych evaluation
(Determination of coping skills); Section
4: Join the e-mail group
to get your 5 patient contacts (Talk to previous MGB Patients) then fill out
http://www.clos.net/patient_contacts_form.htm; Section
5: PreOp Permission Form,
(Show understanding of the surgery); Section
6: Family Permission
Form, (Show your family understands and supports you); Section
7: PreOp Pictures,
(Baseline); Section 8: HIPPA
Form, (Patient Privacy); Section
9: Insurance Release,
(Dr R Does not take insurance); Section
10: Medications and
Allergies, (Double check); Section
11: Contact / Billing
Information, (How to get in touch with you); Section
12: Prescriptions,
(Recommended Pre and Post Op Prescriptions.) Below are the tips to
completing the Packet process
Your Doctors Information
(Doctor's History and Physical Examination and Laboratory Data.)
This section is the most difficult
in some ways the most important. It has been simplified. If possible your
Doctor is asked to fill out the attached "Check Box" History and physical
Form. It includes many little tips and pointers to help your Doctor
complete your preoperative history and physical examination and the needed
laboratory studies. This notebook also includes a letter to your Doctor from
Dr. Rutledge describing the "Check Box" form and other tips and pointers to
safely evaluate your for the MGB. You can read these comments and Dr.
Rutledge's letter but a quick summary is provided below:
Pre-Operative History and
Physical Examination
Dr. Rutledge asks your Doctor to
perform a routine preoperative History and Physical Examination. As a
possible aide in the rapid performance of this examination Dr. Rutledge has
created "Check Box" History and Physical Examination Form that your Doctor
may want to use to shorten the time it takes to perform the examination and
to guide him/her in some of the details in the preoperative preparation
process for special patients.
Other Medical Problems/Other
Doctors/Other Specialists
If you have other serious medical or
psychological illnesses and see another medical doctor for these problems we
would like a letter describing you health issues and giving any guidance
related to your surgery. For example if you see a cardiologist we will need
an examination and letter from your cardiologist and any additional testing
he/she recommends.
Drugs and Medications
Preparing for surgery requires a
careful review of your medications with your Doctor and Dr. Rutledge. Below
are some guidelines, Tips and Pointers:
Warning!! Do Not Stop Any
Drug before Surgery without Careful Discussion with Your Primary Doctor
First
Anti-Depressants: We
usually Do Not Stop Anti-Depressants Before Surgery
Blood Thinners/Anti-platelet
Drugs, Aspirin and similar drugs: We ** Usually ** all blood
thinners/anti-platelet agents, aspirin and similar drugs as well all
herbs, Vitamins and Supplements need to be stopped prior to surgery.
Narcotic/Alcohol/Benzodiazepine/cocaine, amphetamine: Narcotic/Alcohol/Benzodiazepine/cocaine,
amphetamines use are all relative contraindications for Mini-Gastric
Bypass with Dr. Rutledge. We require physician supervised drug
withdrawal programs documented by the physician and patient and family.
(Klonopin use is an absolute contraindication)
Steroids (prednisone etc.):
Steroid use (prednisone etc.) is usually a contraindication to
Mini-Gastric Bypass surgery with Dr. Rutledge
Anti-platelet Therapy
(aspirin or clopidogrel (Plavix)): Our ** Usual ** Peri-operative
Management of Patients Who Are Receiving Anti-platelet Therapy (aspirin
or clopidogrel (Plavix)): stop treatment 7 to 10 days before surgery. We
** usual ** Resuming aspirin when there is adequate hemostasis. Stop
(Plavix) clopidogrel at least 5 days and, preferably, within 10 days
prior to surgery. We prefer "bridging" therapy with a Lovenox 40 mg/d
Coumadin (warfarin sodium): Usually
If on Coumadin (warfarin sodium) there is a $5,000.00 Surcharge. We
usually Stop warfarin 5 days prior to surgery Therapeutic dose sc LMWH
D/C 24 hours before surgery. Resume therapeutic doses of heparin
post-operatively resume warfarin on 1-3 days after surgery LMWH pre- and
post-operative.
Beta Blocker Management: Beta
blockers such as propranolol and atenolol may reduce the risk of
cardiovascular complications for patients undergoing surgical
procedures. Patients undergoing MGB on a beta blocker as a "home" or
"current" medication will receive their usual beta-blocker therapy at
the "usual" time prior to surgery.
Preoperative Laboratory Tests
& EKG
Patients are evaluated for
common issues prior to undergoing surgery. The usual tests are listed
below:
We Recommend Vitamin D Level:
Check for Vitamin D Deficiency:
Vitamin D deficiency is common.
Vitamin D is connected to a variety of other diseases that include
different cancer types, muscular weakness, hypertension, autoimmune
diseases, multiple sclerosis, type 1 diabetes, schizophrenia and
depression. Because gastric bypass can further worsen vitamin D
absorption We recommend Preop patient be tested for and treated for
vitamin D deficiency prior to surgery. (The usual Rx if abnormal is
daily sun exposure, Rx vitamin D deficiency 2,000-7,000 IU vitamin D/d
to maintain D levels 40-70 ng/mL, (1000 IU of vitamin D is only 25 μg;)
We Recommend H. Pylori Test:
Check for H. Pylori Infection:
H. pylori is responsible for
most ulcers and many cases of stomach inflammation (chronic gastritis)
and many stomach cancers.
Since weight loss surgery can
also cause stomach ulcers and gastritis the combination of H. Pylori and
stomach surgery can be additive. We now recommend that all patients
undergo preoperative testing and treatment for H. Pylori if found.
Usually Treatment for taken for
10 to 14 days. Medications may include: Two different antibiotics, such
as clarithromycin (Biaxin), amoxicillin, tetracycline, or metronidazole
(Flagyl), Proton-pump inhibitors, such as omeprazole (Prilosec),
lansoprazole (Prevacid), or esomeprazole (Nexium) Bismuth subsalicylate
(Pepto-Bismol), in some cases.
Test: CBC Complete Blood
Count (Hemoglobin and Hematocrit) Look for Iron Deficiency (Common in
Women)
Low blood iron levels (iron
deficiency) anemia is common in American women (3%) because of menstrual
blood loss. Weight loss surgery can exacerbate this problem and we
require preoperative assessment and initiation of treatment in
conjunction with your Doctor’s advice. (Usually STEP 1; See your
gynecologist to decrease monthly blood flow!, STEP 2: Iron deficiency
anemia Dx/Rx if abnormal: Proferrin, Heme Iron Polypeptide,
http://www.coloradobiolabs.com/
http://www.coloradobiolabs.com/ClinicalStudies/Studies.aspx Am J
Kidney Dis. 2003Aug;42(2):325-30 PROFERRIN (Iron) WARNINGS Accidental
overdose of iron-containing products is a leading cause of fatal
poisoning in children younger than 6 years. Keep this product out of
reach of children. If overdose does occur, seek immediate medical
attention or call a
poison control center.
Preoperative EKG hypertension;
chest pain; congestive heart failure; diabetes; cerebral vascular and
peripheral vascular disease; syncope or presyncope; dizziness; shortness
of breath; dyspnea on exertion; paroxysmal nocturnal dyspnea;
palpitations; leg/ankle edema; and abnormal valvular murmurs.. *An EKG
performed within 3 months of scheduled surgery is acceptable unless
there has been a change in the patient’s medical status requiring a
repeat EKG. If you do not think an EKG is clinically indicated it may be
omitted. “Abnormalities on preoperative ECGs are common but are of
limited value in predicting postoperative cardiac complications in older
patients undergoing noncardiac surgery.”
Chest x-ray is
recommended for patients: with significant cardiac, pulmonary or
neoplastic disease or when indicated by the primary care physician (A
chest x-ray taken within 6 months of scheduled surgery is acceptable
unless there has been a change in the patient’s medical status.)
Urinalysis is
only indicated at the request of the primary physician.
Liver Function Tests indicated;
only for History of recent/active liver disease or biliary tract
disease, etc.
Digoxin level=On Digoxin,
Lithium, Dilantin On Lithium, Dilantin (phenytoin) or other
anticonvulsant drugs (phenytoin), phenobarbital, Tegretol/Carbatrol
(carbamazepine), Depakote (valproic acid) level
The preoperative process
includes a psychological
evaluation. This can be with a psychiatrist or psychologist. You will
need a letter from him stating that you’re capable of making a proper
decision and of making the life changes that will take place as a result
of surgery. You need to show that you do not have an alcohol or other
drug problem and that you do not have an active mental illness which is
untreated or which would render you unable to do the self-care that is
necessary following gastric bypass surgery.
As part of the preoperative process
we ask that you talk to five MGB patients before having the surgery.
The New
Packet Requirements: You ONLY Need five Patient Contacts! A
good way to meet former MGB patients is to join our on line mailing list.
To join, go to http://health.groups.yahoo.com/group/Mini-Gastric-Bypass. Then fill out http://www.clos.net/patient_contacts_form.htm
The required number of patient
contacts has been decreased from 10 to 5. You need to make contact with **
FIVE ** former patients who have had the MGB. Another easy way to do this is
to go to http://www.mgbhelp.com. Also you can email all of the CLOS Staff at
EveryOne@clos.net for help.
Once you have five contacts, go to http://www.clos.net/patient_contacts_form.htm Be sure to print what next appears on your screen and include it with your packet.
The patient letter and the
Preoperative Informed Consent have been combined. The patient letter
requirement has been replaced by completing the Informed Consent Form. A
separate patient letter is no longer required.
Fill out and sign the Consent Form. The consent form is included later in this file under Section 10. It says, do not sign until you’re with a health professional witness, but the copy that you are mailing in with your packet needs to include your signature and date. You will need TWO copies of this. One will go in your notebook and be sent with your packet. The other copy needs to be brought with you when you have surgery. You will be given another on a hospital form to fill out so if you have your copy with you, you can just copy it over onto the properr form. A nurse in the holding area will witness your signature..
The family support letter has been replaced by the Family Consent Form. It is much the same as the Patient Consent Form. It must be filled out by a member of your family who will be in your life to support you through the surgery and beyond. This can be your mother, father, sister, brother, husband, wife, adult child or life partner. This form should be filled out completely and signed then notarized just as the former family support letter needed notarization. This should be returned with your packet signed and notarized. You may want to assist your support person in understanding what you have learned about the surgery and the risks and benefits. In fact, it's a good idea to sit down with your support person and together read, discuss and fill out the form. This consent form is purposely complete listing every possible risk. We want you to be a well-informed patient and have well-informed people to support you.
You will need two pictures of
yourself. Wear something that will show your body shape clothed, so that the
doctor will know before he meets you where your weight is concentrated.
Please also submit a photo of your abdomen if you have a significant scar on
it. This is helpful to determine if its location may be something the
surgeon needs to be aware of prior to your arrival for surgery. Note, all
photos are only reviewed and placed in your private medical chart of the
CLOS office. There will be NO publication of these photos unless you were to
submit or display them online or any other means of publication. We prefer
4X6 color prints.
Sign and date the HIPAA form under
Section 8
This is a two-part process.
There are two forms. Everyone must sign the release form whether they
are paying cash or not. The form clarifies whether or not you will be
working with the hospital to bill insurance (if pre-certified with St.
Rose). The second part of the form is the form you will need if you
intend to seek reimbursement from your insurance company. This is a
9-10 page form that is based on the information you supplied in your
original patient information form (patient application). If you are
asking for an insurance letter, the request form must be notarized.
There is a $25 fee for this form, however many patients have found it
very helpful. If you plan on having the hospital bill your insurance
please contact Linda Johnson at (702) 616-5000 after you have a surgery
date.
Complete the sheet enclosed. This form will provide us the most current list of medications and supplements.
Complete the form with your information.
Because of changes in the laws we no longer offer to send out prescriptions. Sorry. You can take these suggested enclosed prescription sheets to your doctor and he can have them filled prior to arriving in NV for surgery or we can fill them after clinic in Las Vegas. Please checkwith Sandy Brubaker, sandyb@clos.net to confirm you have picked them up. There is nothing to submit in the packet with this section. Once your packet is complete:
Your packet must come to us in a
folder. Make sure it is completed before sending it. If you receive your
notebook in the form of a CD or electronic file, please purchase dividers
with labeled tabs for each section and mail in. Your packet must be received
not less than 14 days before your desired surgery date. Your packet should
be sent Fed-ex, Priority Mail, or UPS. It should ** NOT ** require a
signature.
Dr. Robert Rutledge
CLOS
98 E. Lake Mead Pkwy, Suite 302
Henderson, NV 89015
Office Phone: 702-714-0011
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