Wednesday, October 07, 2015

Wednesday, May 27, 2015

This was a nice day - you would be surprised at how nice and accessible our Utah public servants are. They are dedicated, good listeners. They cannot always make everything turn on a dime, but with citizen input, can help move policy and make our state healthier!

Your advocates today (MANY others who work every month could not get to todays meeting) Attorney Kimball Christensen, Businessman/Patient/Advocate/Councilman Jeff Haaga, Surgeon Dr Anna Ibele from University of Utah, BMI manager Darren Cluff.

Many thanks to Insurance Commissioner Todd Kiser and Assistant Commissioner Tanji Northrup for our second visit as an ASMBS and OAC group... We are looking forward to bringing grassroots to the Utah Legislature in the Interim - every third Wednesday this year! Come join us.

Sunday, May 10, 2015

Packlist for going home after surgery Pain, Nausea, Wounds, Dehydration, Constipation, Fatigue---"Normal" is weeks away!


90% of what you and your loved ones worry about is not going to happen.

Most problems are not life threatening, and even those that are life threatening rarely actually kill... Relax just a tiny bit!

BUT..... GO TO THE EMERGENCY DEPARTMENT OR CALL 911 IF YOU TRULY FEEL LIKE YOU ARE DYING. It is better to be wrong and get checked out, than to play it cool and be dead at home. If you call a doc and say you are terribly ill, they are going to get you in to be seen in person, and have tests.

It is always best to be seen in your surgeon's "regular" hospital for abdominal problems if time allows. Your local ER can do many things (especially chest pain, shortness of breath, wound problems, or clot treatment)- but do not be surprised if you end up transferred for certain problems. Not all hospitals have the same areas of knowledge, and you need to be a careful consumer.

PAIN is a normal part of healing. It is not always a sign of trouble. Every day will get a bit better for most patients, and by 3 or 4 days after surgery, many can have good relief with plain Tylenol for most of the day.

The most common problem I see is not keeping a steady level of medication. Most pills or Elixirs only give 4 to 5 hours of effect - so make sure you don't go more than 6 hours between doses (ESPECIALLY OVER NIGHT! Set the alarm so you don't wake up in pain with all of your medication worn off.) If you don't like the "fuzzy" feeling that narcotic gives you, then cut the dose of that part down, but keep getting the full dose of Acetaminophen (Tylenol). Do NOT take more than 3,300 mg per day or more than 1000 mg in any one dose, though.

Everyone has nausea to some extent. It cannot be eliminated with medications. The stomach is going to cramp. Vomiting once or twice a day is not unusual, but should be reported to your team if ongoing.

Most people are anxious about how long it will take to tolerate regular food - or some particular food. BE PATIENT!!! Everything is going to be there eventually.

Every wound is a worry. The only ones we do much about have severe redness more than an inch in all directions. Redness of just a quarter inch (4-5mm) is usually part of the healing process. Wounds often "gape" open for a quarter of an inch, and often go down a quarter of an inch with scab or even white fibrous goo. This is not usually "pus" but normal protein coagulum from tissue and plasma.

DEHYDRATION is the most common reason for being put back in the hospital, and it is usually avoidable! Don't panic at how things cramp a bit - keep taking small swallows of liquid, and do not try to go too fast or too big. If you try to eat regular food too fast, then you may feel too sick to drink - then you are stuck back in a hospital bed with IV fluids, a scared family, and maybe a big bill. If you can get some fluids down, but just are not quite keeping up, many offices can give extra IV fluids during the day, without having to use the hospital (and for a lot cheaper).

Constipation is usually just much slower bowels from less food, narcotic effects, minimal exercise, and dehydration. Expect that you may only have a Bolwel Movement once or twice in the first week after surgery. If you really feel stuck, a dose or two of Milk of Magnesia or similar can help, but if you are truly pooping hard rocks, a Fleet's enema is the only real help. Not many people like this, and not many have to do it - but don't be afraid to do one at home, before resorting to the ER.

Most people notice their energy is not 100% for 3 months after any major surgery, but usually it is 85% by 4 weeks out. Do not try to "push" beyond this - just take care of the important stuff first, and punt on the stuff that can wait. BE VERY CAREFUL WITH THE CAR! If you find you are "wiped out" after a day at work (or whatever) - do not make a long drive assuming you will be ok. If you have a crash, we cannot take that back!!!

It is OK if your weight is UP after surgery - fluid retention is very common. Just keep following it, and you will be happy by the end of a week or two. We are mostly just looking for an average of 1 or 2 pounds per week over the first year - do not try to push beyond this. Many people will lose more in the first 30 days, but it is probably more important to be consistent, and keep strong muscles and bones for the long term... Expect occasional "plateaus" where your weight stays the same for a few weeks, or even goes up a pound or two.

Did I say not to panic? :-)
Any care needs to be individualized by your doc, pharmacist, or their team - this is only for general information.

Find the quiet inside the chaos. Take a breath and listen.

Monday, January 12, 2015

Big News for Utah Medicaid WLS Patients! Coverage of Sleeve Gastrectomy, and no more "6 month" penalty lap

Wow - thanks so much to advocates from all sides. Patients, caregivers, public servants, companies, and the Obesity Action Coalition and ASMBS are all working to obtain equal access to care for obesity.

See below for their quote,

"Utah Medicaid follows McKesson InterQual 2014 criteria for surgical procedures. Within this product, the supervised weight loss criteria point is no longer there. It has been reworded now to be "documented history of weight management attempts" and "unable to maintain sustained weight loss." With that said, we would not require a "medically supervised" diet for any length of time. Utah Medicaid would only require documentation of weight management attempts and failure to maintain sustained weight loss. In conclusion, this places the responsibility on the provider to make sure they document these weight loss attempts. It also allows for them to use their own discretion for the appropriate length of time a patient should attempt these weight management programs. "

Anyone feel like writing letters to Intermountain Healthcare or PEHP to make their coverage as good as Medicaid and Medicare? The time for discriminatory plan design is OVER! (but not without careful monitoring of how things are implemented...)