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VA Boston Healthcare System

 

Qualifying/Planning for Surgery

Thank you for your interest in the Boston VA Healthcare System’s Bariatric Surgery Program.  Bariatric Surgery is a tool to lose weight – it is not a one-time fix.  It is a process that can take 6 months to a year from the time of your consult to the time of your surgery.  Your primary care physician or provider must consult our service (MOVE Bariatric Pre Evaluation) to start this process.  This process requires your dedication to changing your lifestyle, adhering to a diet before and after surgery, and we require that you lose weight and sustain this weight loss before your surgery.  Please review the typical steps that our patients will take prior to surgery.
man running up the stairs
Steps taken prior to Bariatric Surgery at the VA Boston Healthcare System:

Qualifying for Surgery
 
Step 1:  Are you a candidate?  To start the process, you must meet the following criteria:

  o Non-smoker for at least 6 weeks, AND you cannot smoke after surgery (this can cause serious complications with your surgery)
  o Body Mass Index of 35  or higher with comorbidities (Diabetes, High Blood Pressure, etc.) or a BMI greater than 40
  o At least 3 months of regular participation in MOVE! (or a similar program outside of the VA), demonstrating sustained healthy lifestyle changes.
  o No history of alcohol or illegal drug abuse for the past 12 months
  o 10 pound weight loss will be attained and sustained prior to surgery

Step 2:  Consult is placed by your Primary Care Provider for MOVE BARIATRIC PRE EVALUATION
Step 3:  Your consult will be received and your health history will be reviewed by VA Boston Bariatric Surgery service to determine if you are a candidate or what changes you may need to make before you can be considered for surgery.
Step 4:  You should attend (locally or via CVT) a Boston VA Bariatric Surgery Informational session, which is held approximately once per month.
Step 5:  If you are considered a possible candidate for surgery, you will be scheduled to see the Boston VA’s Bariatric Medicine Physician in West Roxbury, MA.  He will meet with you, review your medical history, and make recommendations for testing (labs, x-rays, etc.)
Step 6:  You will be scheduled for 4 separate Nutrition education sessions with the dietitian at your local VA. This is to discuss your current eating habits but also to educate you on the very specific diet after surgery.  Additional sessions may be required and are at the discretion of the dietician.
Step 7:  You will be scheduled for a bariatric psychological evaluation with the Health Psychologist at your local VA.   Additional sessions may be required and this is at the discretion of the psychologist.
Step 8:  You will have the recommended tests.  This usually involves blood work but also can involve breathing tests (testing for sleep apnea and/or testing your lung function), ultrasounds, and possibly a referral to a specialty service (cardiology, gastroenterology, etc.).
Step 9:  You should attend our Bariatric Surgery Support Group, held the first Monday of each month.  This is at our West Roxbury, MA location but can also be set up as a tele-conference (“CVT”) from your local VA site.  Please let either your PCP or your local MOVE team know if you are interested in attending the support group so that we can schedule you for this appointment.
Step 10:  The dietitian and Health Psychologist will notify the Boston team once you have completed your education sessions and evaluation process.  You will also need to meet with our Bariatric Pharmacist (either in person or over the phone) to discuss your current medications and how your medications are expected to change after surgery.
Step 11:  You will be scheduled to meet with the Bariatric Surgeon in Boston (West Roxbury, MA).  At this appointment additional testing may be recommended prior to your surgery.  If no additional testing is needed, and a tentative date for surgery will be set.
Step 12:  You will have the additional tests performed, if requested by the surgeon.
Step 13:  If you had additional testing or appointments recommended by our surgeon, you will come back to meet with the Bariatric Surgeon in Boston (West Roxbury, MA), a tentative date for your surgery will be provided.
Step 14:  You will be seen by PATC (Pre-Admission Testing) in Boston (Jamaica Plain, MA) within 30 days of your surgery.  Here you will be seen by Anesthesiology, Nursing, Social Work, and will have labs drawn.
Step 15:  You will have surgery in Boston (West Roxbury, MA).  Depending on the type of surgery you have, your average hospital stay will be 3 to 5 days.
Step 16:  After you are discharged home, you will be seen after surgery at 3 weeks, 3 months, 6 months, 9 months, 1 year, and then yearly by various team members (physicians, dieticians, psychologists).  We can help arrange appointments for you if you need to be seen more frequently by the medical, surgical, nutrition or mental health teams.

Your Local MOVE Bariatric Team:  Also note that several of your appointments will be held at your local VA – we work closely with the MOVE Bariatric team members at other VA sites within our VISN including:

  -VA Boston Healthcare System in West Roxbury, MA and Jamaica Plain, MA
  -Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA
  -VA Connecticut Healthcare System in West Haven, CT
  -VA Central Western Massachusetts Healthcare System in Leeds, MA
  - Providence VA Medical Center in Providence, RI
  -Togus/ VA Maine Healthcare System in Augusta, ME
  -White River Junction VA Medical Center in White River Junction, VT

Some of our Patients are seen at their local CBOCs.  Please note that we do not have a service agreement with The Manchester, NH VA Medical Center. 

Planning for Surgery

Once you have been seen by the surgeon and deemed an acceptable surgical candidate, we will work with you to schedule your surgery.
 
You will be seen at the Pre Admission Testing Center at the VA Boston Healthcare System Hospital in Jamaica Plain, MA.  Your visit will be on a weekday morning, and you will be there for approximately 4 hours.  You will be seen by Anesthesiology, Nursing, Social Work, and you will have blood work drawn and you may also have an EKG and X-Rays that morning.  Your PATC visit needs to be completed 30 days prior to your surgery date.  Once you have been scheduled for PATC, you will receive a letter which discusses what to bring and what to expect./BOSTON/services/images/PACTPatientLTR.pdf 
  
We can help to arrange lodging at our Huntington House the night before PATC for patients who live more than 50 miles away from our Hospital.  http://www.boston.va.gov/services/social_work/huntington_house.asp 

Your surgery will be performed at the VA Boston Healthcare System Hospital in West Roxbury, MA.  Typically you will be hospitalized for 4 to 5 days after your surgery.  While you are hospitalized, we can help arrange for your family to stay at the Fisher House if your family lives more than 50 miles from our Hospital.     http://www.boston.va.gov/services/Fisher_House_Boston.asp   or http://fisherhouseboston.org/

We also have a list of local hotels which are convenient and some offer discounts to our patients’ families./BOSTON/services/images/DiscHotel.pdf 
 
These booklets are provided to patients after surgery and discuss what to expect during recovery. /BOSTON/services/images/DischargePacket.pdf    /BOSTON/services/images/DischargeSleeve.pdf 
 
After your surgery, the Boston VA Bariatric Team (Surgeon, Dietician and Psychologists) will see you at follow up appointments after your surgery on the following schedule:  3 weeks, 3 months, 6 months, 12 months, and yearly for at least 5 years.  Our clinic is held Monday mornings.  If you need additional support from Nutrition or Mental Health, we can help arrange this at your local VA. 

Useful links:

Bariatric Homepage 
Considering Surgery?
Qualifying/Planning for Surgery
Preparing for Surgery
Pharmacy and Medications after Surgery
Non-surgical weight loss options
Meet Our Patients
Helpful Websites