Weight Loss Surgery, Gastric Bypass
   
 
   
Bridges Weight Loss Center is a comprehensive surgical weight loss clinic offering Weight loss Surgery, Gastric bypass, Gastric banding, Lapband, Realize band, Sleeve Gastrectomy in Dallas, Austin, Houston, Texas USA

  1. How often are your seminars?
  2. I feel that weight loss surgery is the right choice for me. What do I need to do to get started?
  3. How do I choose what operation is right for me?
  4. Do I need a referral from my primary care physician to come see you?
  5. If I want to undergo weight loss surgery, how long do I have to wait?
  6. Why does it take so long to get insurance approval?
  7. What can I do to help the process?
  8. What can I do before the initial consultation to speed up the process of getting ready for surgery?
  9. How can an insurance company deny weight loss surgery to treat a life-threatening disease?
  10. What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
  11. Are there any medical conditions that would prevent me from having surgery?
  12. What if I have had a previous weight loss surgical procedure and I'm now having problems?
  13. How many total visits will I have at the office?
  14. Do you have an age or weight limit?
  15. Can weight loss surgery prolong my life?
  16. Can weight loss surgery help other physical conditions?
  17. How long do the operations last?
  18. When can I return to work?
  19. What are my activity restrictions after surgery?
  20. Will you perform laparoscopic surgery if I have had a prior abdominal surgery?
  21. How much weight will I loose after my weight-loss surgery?
  22. What are the routine tests required before surgery?
  23. Am I required to have any other test?
  24. What is the purpose of all these tests?
  25. Why do I have to have a GI Evaluation?
  26. Why do I need to have a Sleep Study?
  27. Why do I have to have a Psychiatric Evaluation?
  28. What is sleep apnea (SA)?
  29. What do I need to do to prepare for my operation?
  30. Will I be asked to stop smoking?
  31. If I continue to smoke, what happens?
  1. How often are your seminars?
    We hold our free informational seminars at least twice a month. Please click on the "Seminar Schedule" tab on the left to see the dates of our upcoming seminars and location where they are held.
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  2. What do I need to do to get started?
    The first step is to register for a free informational seminar. Once you have learned about the benefits and the risks associated with weight loss surgery you will be scheduled for your initial consultation at our office. You will be able to schedule an appointment at the end of our seminar.
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  3. How do I choose what operation is right for me?
    Your attendance at the seminar will give you plenty of insight into the weight loss surgery options. This information will help you decide which operation is right for you. At your consultation with Dr. Raja, he will help you finalize your decision.
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  4. Do I need a referral from my primary care physician to come see you?
    If your health insurance is a PPO, POS etc., you do not need a referral to seek a consultation with our surgeon. If you belong to a HMO, you are required to obtain a letter of authorization from your primary care physician prior to seeking a consultation with Dr. Raja.
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  5. If I want to undergo weight loss surgery, how long do I have to wait?
    The initial consultation is usually booked within a week of attending one of our free informational seminars. Once you are seen, if Dr. Raja and you agree it is appropriate, the operation can usually be scheduled within 6-8 weeks.
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  6. Why does it take so long to get insurance approval?
    After your initial evaluation is completed, it usually takes us 1-2 days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from about 3-4 weeks or longer. We have an insurance coordinator who will follow up regularly on approval requests.
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  7. What can I do to help the process?
    Gather all the information (diet records, medical records, medical tests) your insurance company may require. This reduces the likelihood of a denial for failure to provide "necessary" information. Letters from your personal physician and consultants attesting to the "medical necessity" of treatment are particularly valuable. When several physicians report the same findings, it may confirm a medical necessity for surgery.
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  8. What can I do before the initial consultation to speed up the process of getting ready for surgery?
    1. Make a list of all the diets you have tried and bring it to your initial consultation.
    2. Bring any pertinent medical data to your appointment with Dr. Raja - this would include reports of special tests that you may have completed recently (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
    3. Bring a list of your medications with dose and schedule.
    4. Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.
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  9. How can an insurance company deny weight loss surgery to treat a life-threatening disease?
    Authorization may be denied because there may be a specific exclusion in your policy for obesity surgery or "treatment of obesity." Such exclusions are difficult to overcome. Insurance approval may also be denied for lack of "medical necessity." A therapy is deemed to be medically necessary when it is needed to treat a serious or life-threatening condition. In the case of morbid obesity, alternative treatments - such as dieting, exercise, behavior modification, and some medications - are considered to be available. Medical necessity denials usually hinge on the insurance company's request for some form of documentation, such as 1 to 5 years of physician-supervised dieting or a psychiatric evaluation, illustrating that you have tried unsuccessfully to lose weight by other methods.
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  10. What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?
    Medical problems, such as serious heart or lung problems can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient's weight, they also increase the need for surgery. Severe medical problems may not dissuade you from having weight loss surgery if it is otherwise appropriate, but those conditions can make your risks higher than average.
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  11. Are there any medical conditions that would prevent me from having surgery?
    Individuals who are able to have general anesthesia are able to have weight loss surgery.
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  12. What if I have had a previous weight loss surgical procedure and I'm now having problems?
    Contact your original surgeon - he or she is most familiar with your medical history and can make recommendations based on knowledge of your surgical procedure and body.
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  13. How many total visits will I have at the office?
    After your attendance to our seminar you will have 2 visits at the office before your operation; an initial consultation to gather your health information and a pre-operative visit to review the surgery and any ordered tests. After your operation, you will be seen at 2 weeks, 3 months, 6 months, 12 months, 18 months, 24 months, and then on an annual basis for the first 5 years for gastric bypass and sleeve gastrectomy patients. For the banding patients visits are more frequent to evaluate the band and to adjust it as needed.
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  14. Do you have an age or weight limit?
    1. The adjustable gastric banding operation is currently restricted to individuals who are 18 years or older by FDA guidelines. Our minimal age for bypass and sleeve operation is 15 years old. There is a concern that young patients may not have reached full developmental or emotional maturity to make this type of decision. It is important that young weight loss surgery patients have a full understanding of the lifelong commitment to the altered eating and lifestyle changes necessary for success. We have set up special guidelines for patients younger then 18 years old.
    2. Patients over 65 require very strong indications for surgery and must also meet stringent Medicare criteria. The risk of surgery in this age group is increased, and the benefits, in terms of reduced risk of mortality, are reduced. We do not have an upper age limit. Dr. Raja's oldest patient to date has been 74 years old.
    3. Individuals must have a BMI of at least 35 to be considered for weight loss surgery. We do not have a restriction for maximum weight.
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  15. Can Weight Loss Surgery prolong my life?
    There is good evidence from scientific research that if you have Type 2 diabetes, or other serious obesity-related health conditions, are at least 100 lbs. over your ideal body weight, and are able to comply with lifestyle changes (daily exercise and a healthy diet), then weight loss surgery may significantly prolong your life.
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  16. Can weight loss surgery help other physical conditions?
    According to current research, weight loss surgery can improve or resolve many associated health conditions, known as co-morbidities, such as high blood pressure, diabetes, high cholesterol, sleep apnea, etc.
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  17. How long do the operations last?
    Adjustable gastric banding operation takes about 30 minutes. Sleeve gastrectomy takes about 60 minutes. Gastric bypass takes about 90 minutes.
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  18. When can I return to work?
    Individuals with banding operation may return to work in as soon as 1 week. Our guidelines state that all of our patients should be able to return to work in 2 weeks.
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  19. What are my activity restrictions after surgery?
    You are able to get up and start walking just a few hours after your operation. You may shower 48 hours after your operation. You may be able to drive in about 7 days after your operation. You can return to work in 2 weeks. You are restricted to lifting no more then 20 pounds for the first month after your operation.
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  20. Will you perform laparoscopic surgery if I have had a prior abdominal surgery?
    Yes. Dr. Raja performs all of the weight loss surgeries laparoscopically. If you have had prior surgeries you may have a slightly increased chance of your operation being converted to an open operation because of excessive scarring, etc.
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  21. How much weight will I loose after my weight-loss surgery?
    The actual weight a patient will lose after the procedure is dependent on several factors. These include: the patient's age, weight before surgery, overall condition of patient's health, surgical procedure, ability to exercise, commitment to maintaining the diet and exercise guidelines and other follow-up care, motivation of patient and cooperation of their family, friends and associates. The medical literature reports typical outcomes as percent of excess weight loss. On the average, patients with adjustable gastric banding will lose 50-55%, sleeve gastrectomy will lose 60-65% and gastric bypass will lose 75-80% of their extra weight.
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  22. What are the routine tests required before surgery?
    Certain basic blood tests are done prior to surgery: Complete Metabolic Profile (CMP), Complete Blood Count (CBC), Urinalysis (UA), PT/PTT, HgbA1c, Thyroid Stimulating Hormone (TSH), H.Pylori, Cholesterol Profile and certain vitamin levels. All patients excluding the very young get a chest X-ray, an electrocardiogram and a pulmonary function tests. All patients are required to have a psychiatric evaluation prior to their operation. Other tests, such as gallbladder ultrasound, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, or, may be requested when indicated.
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  23. Am I required to have any other test?
    Work with your primary care physician to ensure that your routine health exams are current. For example, women should have a pap smear, breast exam, and if over 40 years of age, a mammogram. For men and women over the age of 50 years, a colonoscopy is recommended. If you do not have a primary care physician our office can refer you to one on the day of your initial consultation.
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  24. What is the purpose of all these tests?
    An accurate assessment of your health is needed before surgery. It is important to know if you have obstructive sleep apnea before your operation since this can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Surgery increases cardiac stress therefore, your heart will be thoroughly evaluated. These tests will determine if you have a liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in bodily fluids, or abnormal blood fat levels.
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  25. Why do I have to have a GI Evaluation?
    Patients who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc., may have underlying problems such as a hiatal hernia, gastroesophageal reflux or a peptic ulcer. For example, many patients have symptoms of reflux. Up to 15% of these patients may show early changes in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable surveillance or treatment program can be planned.
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  26. Why do I need to have a Sleep Study?
    The sleep study detects a tendency for abnormal stopping of breathing, known as sleep apnea, usually associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it.
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  27. Why do I have to have a Psychiatric Evaluation?
    The most common reason a psychiatric evaluation is ordered is that your insurance company may require it. Most psychiatrists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic lifestyle changes. The psychiatric evaluation may also help us identify if you suffer from emotional, behavioral or eating disorders that may impact your after surgery care.
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  28. What is sleep apnea (SA)?
    It is the interruption of the normal sleep pattern associated with repeated delays in breathing. Sleep apnea often shows rapid improvement after weight loss surgery. In most patients, there is a complete resolution of symptoms by 6 months following surgery.
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  29. What do I need to do to prepare for my operation?
    Preparation for the operation should began weeks before the operation itself.
    1. You should begin your practice diet as discussed with you at your initial consultation upon returning home.
    2. Dr. Raja also recommends initiating an exercise program from that time on. This will prepare your heart and lungs for the stress of the surgery.
    3. At least thirty days before your surgery date you should stop smoking completely.
    4. Four weeks before surgery you should stop birth control pills and hormone replacement medications.
    5. Two weeks before surgery you should stop aspirin and NSAID products, 1 week before surgery stop taking Plavix, methotrexate, and any herbal supplements you might be taking.
    6. One week prior to your operation should begin a liquid protein diet, avoiding carbohydrates and fats. If you are having gastric bypass or sleeve gastrectomy the night before your operation you should complete your bowel preparation. Remember, nothing to eat or drink after mid night the day before your operation. Dr. Raja recommends Bariatric Advantage nutritional products; you may click on the Vitamins and Nutritional Supplement eStore button on the left of the screen and see packaged items.
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  30. Will I be asked to stop smoking?
    Patients are required to stop smoking at least 1 month before surgery.
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  31. If I continue to smoke, what happens?
    Smoking increases the risk of lung problems after surgery, can reduce the rate of healing, increases the rates of infection, increases the chances of deep venous thrombosis, and interferes with blood supply to the healing tissues hence, increases the possibility of leaks. In general smoking increases the possibility of peri-surgery complications by 10 fold.
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