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I am interested in the “Lap-Band” but
I need more information. What is the first thing that I
should
do?
We hope to answer
most of your questions through this FAQ’s section. If
you have any further questions call Dr. Berbel's staff. She
will send you an information packet and will include details
about our next seminar. Everyone is invited to this seminar.
You do not have to reserve a seat.
I have been to a seminar and received information. Now
what?
Talk to your insurance company and make sure weight loss
procedures are not excluded in your policy. Ask what criteria
they require. Insurances vary in their criteria. Standard
is – A BMI of 40 or above, which is at least 100
lbs over your ideal body weight. Up to one to three other
co-morbidities like high blood pressure, high cholesterol,
diabetes, GERD, back pain, joint pain etc.
Gather all medical records and all recommendation letters
from all doctors and specialists you have seen. The more
information we have to submit to insurance agency the harder
it will be for them to turn you down. A letter from your
PCP (primary care physician) would be great!
Call Teresa at 817-735-5450
to make an appointment. If your insurance requires referrals,
please contact your PCP.
Do I have to see a psychologist from the UNTHSC clinic
or can I see my own psychologist?
An appointment with a psychologist is a very important
part of this surgery. It is not mandatory that you see
our clinic psychologist. You can provide reviews from your
own psychologist, as long as they meet all the requirements.
Three important psychological tests are required before
this procedure – Millon Behavioral Medical Diagnostic,
Eating Inventory, and Minnesota Multi-Phasic Personality
Inventory-2. If you have already taken any of these tests,
it is not mandatory to take them again. But a referral
from your psychologist should be submitted so that the
psychologist at the surgery clinic can review your reports.
Who are the psychologists available at the surgery clinic?
Drs. Susan Franks, James Hall, and Jerry McGill are the
three psychologists at our institution. You can schedule
with the psychologist of your choice. Also available is
another psychologist, Dr. Irwin Schussler, who is in private
practice. The psychologist will interview you for an hour
to assess your mental status and determine if you are an
appropriate candidate for this procedure.
How can I pay for the appointment with the psychologist?
You can pay using your insurance or you can pay by cash.
If you are using insurance please make sure that at least
one of the above mentioned doctors are on your plan. If
your insurance requires a referral for your psychological
evaluation please make sure either you or your primary
care physician obtain one prior to the office visit.
The procedure codes are 96150 and 96151. If you are using
insurance they must be authorized from the medical part
of your insurance plan.
Do I receive any psychological therapy after the procedure?
Yes, if you have received the band, you are asked to attend
group meetings. These meetings are twice a month and are
held in the evening. Your family or others who are sources
of personal support for you are welcome to attend.
Do I have to see a nutritionist?
Yes, our nutritionist, Sharon Yurvati, MSRDLD, will also
interview you for an hour. If you qualify and receive the
band, she will be available to consult with you for a year.
She will help you with a nutrition plan that will be designed
especially for you. This will assist you in getting the
most weight loss from the band possible. Also, if and when
you need an adjustment you must see her first before an
adjustment is made.
How do I pay for the nutritionist?
We accept only cash or credit card for the nutritionist
fees. We do not accept checks & do not bill insurance
for her services. Her initial visit is $65.00. The balance
of $457.00 is due at pre-op. Her services cost $522.00
for one year.
Who are the surgeons who will do the procedure?
Dr. German Berbel
is the General Surgeon who will be performing the “Lap
Band” procedure. You will see them for 30 to 60
minutes during your initial visit. They will assess your past
and present medical history. The procedure code used for authorization
of the “Lap Band” procedure is 43659.
Dr. Berbel will
not perform this procedure with a BMI less than 36 or under
18 years old.
Should I get any other medical referrals or previous medical
records?
Yes, if you have your medical records from your primary
care physician, please bring them for your initial consult.
Any records of detailed medical history, attempted weight
losses, recent labs etc will be useful, as they will be
submitted to the insurance agency for approval.
How long will I have to stay in the hospital?
It is a laparoscopic procedure, so normally only an overnight
stay is necessary. It is considered an out patient procedure
with 23-hour observation.
How long will I need to be off work after surgery?
Dr. Berbel suggests
a week of rest before resuming regular work.
What is the approximate waiting time from appointment
to surgery?
The waiting time depends on the time taken for insurance
approval. The approximate time from the date of appointment
to authorization is 3-4 weeks. The time from the authorization
to the actual procedure depends on the insurance plan.
Will I have a problem taking medications after the surgery?
How can I deal with it?
Dr. Berbel usually
prefers to keep you on liquid medications after the surgery,
if at all possible.
Tell me more about the post-operative care.
The patients are usually discharged within 23-hours, i.e.
next morning, following a barium swallow. The post-op visits
are as follows –
First Post-op visit – at one week
Second visit – at 3 weeks (Blood work is done)
Third visit – at 3 months (Blood work)
Fourth visit – at 6 months (blood work and other
labs, photos are taken)
Fifth visit – after 1 year (another photo is taken)
A visit is required anytime a band adjustment is needed.
What precautions should I take while eating?
It is typically recommended that you not drink fluids
and eat a meal at the same time. There should be a gap
between drinking fluids and eating.
Drink ? wait 15-20 minutes ? eat a meal.
What should I know about band adjustments?
The number of adjustments and when they are done depends
on the person. Usually men tend to lose weight faster and
thus have more frequent adjustments.
Initial adjustments are done in the hospital under fluoroscopic
guidance. The later adjustments can be done in the office
setting.
The number of adjustments ranges from 1 per year to 3–4
per year.
What kinds of foods can I eat after my adjustments?
During the 1st 24 hours – Clear liquids (fruit juices,
jello etc)
2nd day – Full liquids (milk, tomato soup, instant
breakfast etc)
3rd day – Soft solid foods, as tolerated (oat meals,
scrambled eggs etc)
What is “After-Care”?
Support Group meetings
are held twice a month. These group sessions are coordinated
by our team of psychologists. These meetings are held at 6:00
pm in the Patient Care Center (Medical Education Building
4) on the 5th floor lobby on the south side.
What other responsibilities will I have after the surgery?
The surgeon, psychologist, and nutritionist
are there to take care of the surgery and procedure. But the
majority of the responsibility is yours – keep your
appointments, attend the meetings regularly, check your diet,
and exercise regularly. Exercise need not be in the form of
a tiring work out. It can be in the form of simple tasks like
regular walking, taking the stairs instead of the elevator,
parking the car a little farther from where you usually used
to park etc.
What is the rate at which I should lose weight?
Lose it slowly. Don’t hurry. Most men tend to loose
weight at a rate of 4 pounds per week and women at a rate
of 2 pounds per week. However there is no standard for
this rate and it varies from person to person.
How big is the pouch in the stomach that is created by
the Lap Band?
The placement of the Lap Band creates a small pouch in
your stomach, in the size of a tangerine and is capable
of holding about 4 oz of contents.
Suggested ways of restricting your diet after the surgery:
After surgery you will receive a “Card” that
mentions your surgical status. You can use this card in
restaurants to order smaller, kid size meals at the respective
prices. This card is accepted at many restaurants.
Is this procedure FDA approved?
Yes, FDA approved this procedure in
June 2001.
Whom can I contact regarding any further questions?
If you have any
further questions you can contact:
Teresa Hilburn
UNTHSC-FW Surgery Clinic
855 Montgomery St 5th floor
Fort Worth, TX 76107-5022
Ph. No. 817-735-5450
Fax No.817-735-5022
E-mail: surgery@hsc.unt.edu
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