Gastric bypass - psycho

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Do any other nurses deal with post gastric bypass patients and the difficulties they have as a result of their procedure? I find a lot of gastric bypass patients to be extremely rude and demanding. The other day another nurse and I were splitting a room, I had B bed and the other nurse had A bed. The gastric bypass patient in A bed began complaining to her nurse that she wanted regular sugar and jello and not all this diet stuff. The nurse explained to her that the doctor ordered a clear liquid gastric bypass diet and explained the advantages of being placed on that type of diet. The patient did not care she began to yell at the nurse stating that all the other nurses brought her in a regular tray and that she was just being difficult. For the second time the nurse told the patient that she would place a call to the doctor to try to have the diet changed. The patient was utterly obnoxious to the nurse. The nurse walked out and the patient called the nursing coordinator. She explained her exaggerated story to the coordinator. The coordinator must have told the patient that the nurse was handling it appropriately, because I heard the patient say, "you don't see a problem with this?" And began yelling and screaming all sorts of rude things. In report nurses just cringed ever time they have a patient with a history of gastric by bypass, and ask are they psycho? Anyone else find gastric bypass patients to be difficult?:banghead:

my next door neighbor had this surgery 2-3 yrs ago.

she lost approx 150 lbs. and looked fabulous.

i don't know what happened;

but today, she is again morbidly obese, even heavier than she had been.

leslie

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I know many people, includig my own dtr, who have had the gastric bypass..none are what i would psycho, most admit to having problems esp the first year but all that i have talked to state they would do it again in a heart beat. many had iddm, hpt and other health problems that they no longer have to take meds for or that are definitely under control

you will not find mental problems any more prevalent in gp pts than in cardiac or ortho

i know that the pts here have to go thru preop dietitian, psyche, talks with previous pts, talks with the mds and the ed nurses so they were properly prepared...

anything that can improve the quality of life is to be applauded

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I think a big part of this is that we only see the ones who have complications...it seems that there are a lot of them. But there are also a lot of success stories too. I personally can't see having this procedure, but if it's what's right for you, and you're ready to commit to the changes that need to be made, then that's your decision. The psych issue, I think, comes into play when the pts have a lot of psych issues before the surgery and, no matter how much education and counseling they get preop, they just are not prepared to cope with the changes necessary to make this work. They don't take care of themselves the way they need to, and they are the ones that end up back in the hospital...and that's why gastric bypass pts get stereotyped as "psychos". IMHO anyway...

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Specializes in Travel Nursing, ICU, tele, etc.

As professionals, I really wish we would stop using the word "psycho", it is such a slam, as bad as any racial slur in my mind. People don't choose to have behavioral issues.

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Specializes in ER, ICU, Infusion, peds, informatics.

most of us that work in a hospital have a skewed point of view.

[color=#483d8b]we see the patients that have problems/complications and have frequent admissions.

[color=#483d8b]i don't think it is out of line to say that those gb patients that don't follow their instructions/diets are more like likely to be readmitted.

[color=#483d8b]i don't think it is unreasonable to say that those gb patients that have unrealistic expectations of the surgery are going to be less likely to follow their diets and instructions.

[color=#483d8b]and i'm pretty certain that those gb patients that have unrealistic expectations are going to be the same ones that have other psychological issues.

[color=#483d8b]i've been involved in the care of three gb patients (that were being seen due to a gb issue) in my career. one was a fresh post-op, on a floor that (though not a bariatric unit) was the "designated" unit in the hospital for gb patients. i don't remember much about him, other than the care being fairly complex for non-icu. the other two patients were home-tpn patients due to complications from gb, and they had clear psychological issues. (one was using isopropyl (rubbing) alcohol to flush her picc :eek:; let me make it clear that this was *not* how she was taught to flush it).

[color=#483d8b]however, i've taken care of many patients that have listed gb in their medical history, and none stick out at me as being "psycho."

[color=#483d8b]a girl i work with had gb earlier this year. she died less than four months later, due to complications. she had several readmits before she passed away. she was a really, really good person (and i wouldn't call her "psycho"), but i don't think she was psychologically ready for the surgery. i don't think she was ready to make the necessary changes in her lifestyle. however, she was so desperate (her words) to have the procedure done that i think she convinced herself, and the professionals that evaluated her before the surgery, that she was ready. things that she said after the surgery make me suspect that she didn't follow the instructions/diet. i don't know if that contributed to her death or not, but her last few days were just horrible (icu, ventilator, pressors, dialysis, multiple surgeries). very sad.

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Specializes in ER, Occupational Health, Cardiology.
well, mark, have you got any ideas? when we go into the surgeons for these surgeries, one of the questions we are asked, usually a number of times, is what have you done to try to lose the weight and how long have you had a problem with being overweight. we were sending my little brother to the corner store to buy the bigger bags of candy (not candy bars) when i was in high school. my mother had cake or cookies on the table every night for desert, ice cream every saturday night and could she bake! i weighed 190 when i graduated from high school and only went up from there. believe me, these surgeons know what has gone in to making us overweight even though they still ask us the questions. the only ones who don't understand, it seems, are the many others who have no clue about this condition. it's not a matter of instituting preventative measures. if it were, i'd have been wearing a size 8 a long time ago. this is a multi-faceted and complex problem that also involves some very deeply ingrained behavioral issues.

in the bariatric practice that did my surgery, we had to document how many times in our lifetime we had tried to lose weight and how. i think this is a multi-faceted question. first, to let the mds know how serious you have been about losing weight, and how seriously you might take having the surgery. second, the insurace companies are absolute bears:madface: to work with, and they are often the source of weird questions like that. in order for the mds office to get approval for the surgery, they have to be able to document prior attempts at weight loss. many insurance companies still will not approve it.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
in the bariatric practice that did my surgery, we had to document how many times in our lifetime we had tried to lose weight and how. i think this is a multi-faceted question. first, to let the mds know how serious you have been about losing weight, and how seriously you might take having the surgery. second, the insurace companies are absolute bears:madface: to work with, and they are often the source of weird questions like that. in order for the mds office to get approval for the surgery, they have to be able to document prior attempts at weight loss. many insurance companies still will not approve it.

yes, i did too. i went to two different surgeons for consults. for one i had to list them. couldn't remember them all! the other had a list i just had to check off. i ended up checking off pretty much all of them!

i think you're going to be seeing a change in the insurance coverage of this procedure. medicare is already paying for the surgery for people who have medicare and medicaid as their medical insurance. and, they don't pre-certify anything. once you see medicare starting to pay for services like this, the private insurance companies will often follow suit. medicare has the ability to track and trend services being provided because of all the mandatory reporting from all 50 states that comes to them by way of all the different data sets of healthcare information that they require as part of receiving medicare and medicaid reimbursement. so, when they make a decision to start paying for certain procedures (like gastric bypasses), i'm sure their bean counters have looked at the $$$ implications of it very thoroughly. medicare does place the restriction that the surgery has to be done in a "bariatric surgery center of excellence" which is a hospital which meets the surgical standards of the american society for bariatric surgery (http://www.asbs.org/). you can find centers of excellence (hospitals that can do this surgery) and surgeons on their website. you've got to hand one thing to doctors. they do a good job of policing themselves and this "bariatric surgery center of excellence" award was something they came up with to control the quack surgeons who were taking advantage of people clamoring for this surgery. in the process, it's probably going to end up making it available to more people.

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Specializes in ER, Occupational Health, Cardiology.
medicare does place the restriction that the surgery has to be done in a "bariatric surgery center of excellence" which is a hospital which meets the surgical standards of the american society for bariatric surgery (http://www.asbs.org/). you can find centers of excellence (hospitals that can do this surgery) and surgeons on their website. you've got to hand one thing to doctors. they do a good job of policing themselves and this "bariatric surgery center of excellence" award was something they came up with to control the quack surgeons who were taking advantage of people clamoring for this surgery. in the process, it's probably going to end up making it available to more people.

;)both my doctor and his partner are listed at the website. the website is one of the educational tools that they make available to interested persons, even before they become 'official' pts of their practice. thanks for the insurance info. i was fortunate that mine was covered, but here in ga fewer and fewer insurers are covering the surgery. for people who have their "heads on straight" it is a wonderful thing. one of the nurses that i worked with had it done, and one of the first things she ate that was solid food was trail mix with m&ms in it! by the time she missed her 6 mo f/u visit, she was taking diet pills!:nono::down: i haven't worked with her in a few years so i don't know how she has done subsequently.

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Specializes in acute care.

Wow, how is that possible? I knew that one could gain weight but to get bigger than you originally were? How does it happen if you get sick eating more than you are supposed to?

my next door neighbor had this surgery 2-3 yrs ago.

she lost approx 150 lbs. and looked fabulous.

i don't know what happened;

but today, she is again morbidly obese, even heavier than she had been.

leslie

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Specializes in Medical and general practice now LTC.
Wow, how is that possible? I knew that one could gain weight but to get bigger than you originally were? How does it happen if you get sick eating more than you are supposed to?

unfortunately pouch can stretch especially if abused and start eating all the wrong stuf in excess

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Wow, how is that possible? I knew that one could gain weight but to get bigger than you originally were? How does it happen if you get sick eating more than you are supposed to?

there's another weekly show i have watched: big medicine.

father and son surgeon team, who only do gb's. (i think it's on the learning channel)

this week, the father surgeon was counselling a client and he said, quote "it is impossible to gain your weight back".

i know this to be not true.

i do know my neighbor had her share of complications the first year, in and out of the hospital.

i truly don't know how she regained her weight, i.e., what she ate and how often.

that other show i referenced, "inside brookhaven obesity clinic", (another tlc show), i've noticed that a good majority of these pts get denied by their insurance.

but... many of these pts are 450+ lbs.

the ones that get shown ea week, are frequently 700-900 lbs.

i do know these pts have to lose a certain amt of wt before they're even eligible for surgery.

leslie

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Specializes in LTC,Hospice/palliative care,acute care.
I'm also about 100 pds. overweight, though at this time I really have no health issues, other than severe depression. I think maybe some people are just built a certain way with a certain number of fat cells. I've thought of lap band surgery but now I don't think I would go for it, one reason is that when a person has their digestive tract altered like that they suffer from malabsorption. I know of a woman who won't even subject her co-workers to the aftermath of a trip to the bathroom and instead goes down the street to use the gas station. Another woman I know personally who had the procedure done has so much loose skin and sagging it looks absolutely horrible and that couldn't be healthy, either.

I'll stay a big chubbo with my missing front tooth, thank you.

The lap band is restrictive only-not malabsorptive.I'll cop to it-I had it a year ago-I am loosing wt slowly and because of that I'm not sagging and hanging.Nothing different at the other end.I was lactose intolerant for a few months post-op but that is no longer a problem (but it was FOUL- PU! but I know plenty of non lap/banders with lactose intolerance) The band is easily adjusted and can even be removed but serious side effects are not really common...It is a REMINDER-it makes you slow down and eat small amounts of food-small bites chewed really really well.If you fall back into your old habits of just grabbing and cramming junk you'll throw up.Scarfing and barfing is NOT fun. It seemed that after I hit a certain age and wt the co-morbidities started to pile up.Long standing depression has been fairly well controlled but then I got hypertensive,my cholesterol is high and I have moderate sleep apnea.With just 15 lbs off the b/p is WNL and I'm off that med.After about 25 lbs the sleep apnea has improved drastically.I still have high cholesterol and can't take statins but am low risk and am not going to take any thing for it at this time because my good cholesterol is sky high,too.... I would suggest you get some more information before you decide.....

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