General Surgery Articles

Article / Updated 03-26-2016

One of the happier moments in your weight loss surgery journey is when you get the seal of approval from your insurance company. Most insurance companies realize the long-term effects and cost savings associated with the weight loss that occurs after patients have weight loss surgery. For example, if you have diabetes, your insurance company will spend thousands of dollars covering your medications and treatment. Paying for one gastric bypass procedure is likely less expensive for the insurance company than paying for your diabetes medications and treatment for the rest of your life (not to mention paying for any other complications that may arise down the road as a result of your obesity). Unfortunately, obtaining insurance approval is not always easy. Acquiring insurance coverage for weight loss surgery can be a major obstacle to finally achieving a healthier body and life. Over the past few years, insurance carriers have seen a significant increase in the demand for weight loss surgery procedures. According to the American Society for Bariatric Surgery (ASBS), 16,200 weight loss procedures were performed in 1994. Ten years later, in 2004, an estimated 140,640 surgeries were projected to take place — that's more than an 800 percent increase! The average cost for surgery is now approximately $25,000. Due to this increase in procedures and cost, some insurance companies are making it more difficult for patients to obtain approval. These insurance companies don't view their policyholders as long-term responsibilities and figure their customers will switch carriers before they can recoup their investment. So what hurdles will you have to cross? Most companies require what's called a letter of medical necessity from your bariatric surgeon and your primary-care physician. The following information is generally what's required in this preauthorization letter: Your height, weight history, and body mass index (BMI) A description of your obesity-related health conditions, including records of treatment A detailed description of the limitations your obesity places on your daily activities A detailed history of the results of your dieting efforts, including medically- and non-medically-supervised programs A history of exercise programs, including receipts for memberships in health clubs Ask your doctor to include information from medical journals regarding the effectiveness of weight loss surgery, especially information demonstrating the control or elimination of obesity-related health conditions. Many carriers also require a nutritional consult and psychological evaluation. Your surgeon will take care of referring you for these consultations. A number of carriers now require detailed documentation of participation in a physician-supervised diet. Most require the submission of at least six months' worth of office notes from the supervising physician, including proof of dietary supervision and recorded weigh-ins. Not all primary-care physicians support weight loss surgery. Your physician may not be up to speed on the latest techniques and safety reports; he may only be familiar with older procedures that had higher risks. Don't be discouraged. You can bring information to your doctor to try to change his opinion. If your primary-care physician cannot be persuaded, you may have to find another primary-care doctor who understands the necessity for your surgery. Request letters and documentation from any medical professionals who treated you for health-related conditions caused by or aggravated by obesity. Make sure all the letters are sent directly to you (as opposed to your doctor's office), so you can determine if they're supportive of your case. Be sure to make copies of the letters for your records. In addition, forward to your surgeon anything that documents difficulties related to morbid obesity such as: High blood pressure Diabetes Cardiovascular disease Sleep apnea Gastroesophageal reflux Infertility Arthritis Dyslipidemia (a disease characterized by a high concentration of lipids and cholesterol in the blood; a risk factor for heart disease and cardiovascular disease) Urinary stress incontinence Other obesity-related conditions Other important information to provide your surgeon includes Your weight history, demonstrating a history of morbid obesity Your current medications Your psychiatric history Your musculoskeletal history, like joint pain, bone fractures, and osteoarthritis Any allergies you have Each weight loss surgeon's practice has its own way of managing financial and insurance issues. Someone in the office should be able speak to you about your insurance concerns and questions. Most of these advisors are familiar with the ins and outs of working with specific carriers. Being familiar with your own policy is still important. Even the most well-informed advisor won't know all the details of your specific policy without some investigation.

Article / Updated 03-26-2016

Your knee pain has gotten so bad that it’s keeping you from doing many of the things you enjoy. You can’t kneel to work in your flower beds or stoop to play catch with your grandkids. And forget walking the back nine of your favorite golf course, you can barely make it through the front nine. Arthritis medication isn’t doing the trick anymore and your doctor is recommending total knee replacement. Undergoing surgery is a scary prospect for most of us. Fortunately, knee replacement surgery is a fairly common procedure with a record of good results. Nearly half-a-million people undergo knee replacement each year and 95 percent of those people experience a big reduction in pain and a big increase in mobility. Damaged cartilage and bone are replaced by metal and plastic Your knee replacement will be performed by an orthopaedic surgeon, a doctor who specializes in treating bone and muscle problems. While your doctor will give you specific surgery-prep instructions, count on not being able to eat anything after midnight on the day of the procedure. You probably won’t have to arrive at the hospital until the day of your operation, but you’ll have to stay there for several days of recuperation afterwards. When you arrive in the operating room, you’ll either be put to sleep using general anesthesia or you’ll be kept awake but given spinal or epidural anesthesia that will numb your legs. Your surgical team will decide which type of anesthesia would be best for you. Your surgeon will tell you the amount of time he’ll need and the specific steps he’ll take to replace your knee. Generally, total knee replacement takes about two hours. During this time, your surgeon will bend the affected knee in the air and make an eight- to ten-inch incision. Then he’ll move your knee cap out of the way and take out the cartilage and bone that comprise your old knee. He’ll attach the new knee to your thigh bone (femur) and shin bone (tibia) and also to your knee cap (patella) using bone cement. Then he’ll turn and bend your knee to make sure the prosthesis fits and functions properly. When your surgery is over, you’ll be taken to recovery where you’ll be monitored for a couple hours until you’re fully awake. While artificial knee designs and materials can vary, most consist of three parts: a femoral portion made of a strong metal, a plastic patellar piece, and a tibial component, which is often plastic and metal. Careful, consistent movement is key to knee replacement recovery Although you’ll be spending several days in the hospital so you can be watched for any signs of infection, blood clots, or nerve damage, you won’t be wiling away the hours lying still in bed. As a matter of fact, you’ll probably be instructed to begin moving your foot and ankle right after surgery to prevent swelling and blood clots. Because blood clots are the most common complication of knee replacement, your doctor may also require you to wear a compression boot, take blood thinners, and elevate your leg. The day after your surgery, you’ll start walking with the aid of a walker or crutches. Your doctor may also have you use a continuous passive motion machine, a device that will slowly bend your knee while you’re in bed. Within a day or two, a physical therapist will show how to perform exercises specifically designed to regain your leg strength and knee mobility. You’ll need to perform these exercises several times a day for many weeks. Knee replacement isn’t minor surgery, so expect to experience pain and discomfort during your recuperation. While your doctor will give you medication to ease your discomfort, be sure and tell him if the amount of pain you’re experiencing isn’t manageable for you. Life with your new knee Be patient with yourself and your new knee. During your first few weeks home after surgery, you’ll need to focus on following your doctor’s exercise and incision-care regimen so you regain knee strength and mobility and protect yourself from infection. By doing so, you should be able to resume most normal daily activities, such as running errands, driving, and doing minor household chores within six weeks. Once you’re fully recovered, you’ll be able to climb stairs, play golf, swim, and ride a bike. What you won’t be able to do is jog or run, participate in a step aerobics class, or play basketball or any other sport that requires you to jump up and down. Hiking, skiing, tennis, and lots of heavy lifting are also not recommended, so be sure and ask your doctor if you’re not sure about a specific activity. Remember, your artificial knee can break. However, if you steer clear of high-impact activities, protect yourself from falls, and guard against infection, your knee replacement could last 10 to 15 years. Infection can occur in your knee years after you’ve had surgery. Be sure to call your doctor if you notice sudden swelling, pain, and redness in your knee. Also, don’t forget to tell your dentist about your knee replacement. If you need dental surgery, you’ll have to take antibiotics before the procedure.

Article / Updated 03-26-2016

What type of recovery you’ll experience after having your uterus removed depends largely on the kind of hysterectomy you have. Generally, abdominal and radical hysterectomies bring the greatest post-operative pain and the longest recovery times. Vaginal and laparoscopic hysterectomies are comparatively less painful and require fewer weeks to recover. Expect to spend three or four days in the hospital after an abdominal or radical hysterectomy (where your cervix, part of your vagina, and nearby lymph nodes are also removed). If you’ve had either a vaginal or laparoscopic procedure, your stay will be just one to three days. A hysterectomy can be performed in several ways. In an abdominal hysterectomy the surgeon removes your uterus through an opening she makes in your lower abdomen. If you have a vaginal hysterectomy, your uterus will be removed through an incision made in your vagina. In the laparoscopic procedure, your surgeon will remove pieces of your uterus through small cuts in your abdomen. No matter what type of hysterectomy you undergo, once you’re alert you’ll be asked to get up and move as much as you’re able to prevent blood clots from forming in your legs. You’ll take painkillers to manage any discomfort and antibiotics to help prevent post-surgical infections. You might also have to urinate through a catheter for one or two days after surgery. If not, your doctor will want you to use the bathroom on your own as soon as you can. In addition, you’ll have post-operative vaginal bleeding for several days and will need to wear sanitary pads. If you’re recovering from a laparoscopic or vaginal procedure, you’ll probably experience less pain and less bleeding than if you’ve undergone an abdominal hysterectomy. Your recovery time will be shorter too — three to four weeks as compared to four to six weeks for an abdominal surgery. As a matter of fact, many women who’ve had a vaginal hysterectomy report feeling much better just one week after surgery. However, even after a less-invasive hysterectomy, you won’t be able to douche, wear tampons, lift anything heavy, or have sexual intercourse for six weeks. If you’re also having your fallopian tubes and ovaries removed at the same time you have your hysterectomy, you’ll immediately enter menopause and probably begin suffering side effects because your body is no longer producing estrogen. Talk with your doctor about taking hormone replacement to alleviate hot flashes, vaginal dryness, and sleep difficulties. Having a hysterectomy can impact your sexual responsiveness. On the downside, it will eliminate the pleasure of uterine contractions that some women experience during orgasm. On the upside, it can make intimacy more pleasurable for women whose hysterectomies have eliminated gynecological pain or concerns about unwanted pregnancy. Also, studies show that sexual satisfaction is not impacted by the type of hysterectomy a woman has. You may also find your emotional state changes as a result of your hysterectomy. Some women feel a sense of freedom from pregnancy concerns, periods, or chronic pain. Others are sad because they’ve lost a part of themselves and their ability to bear children (if they were premenopausal). You’ll still need to get your regularly scheduled Pap smears in the years following your hysterectomy. The only exception is if your cervix has been removed for non-cancer-related reasons. And every woman who’s had a hysterectomy still needs to pay an annual visit to her doctor for a pelvic exam and mammogram.