Is surgery a good option for you?

Do you want to live longer, have more energy, look better, and feel happier? No, this isn’t an infomercial for the latest weight loss pill nor have I discovered the Fountain of Youth. In fact, most people already know what it takes to achieve the kind of results that I’m referring to. However, knowing isn’t doing. And doing isn’t always as simple as it sounds. If you haven’t figured out the path that I’m leading you down, then here it is: Diet and Exercise. It’s no secret that physical activity adds years to your life… But why is that? Excess body fat leads to changes in your body’s ability to metabolize sugar and insulin, interferes with your hormone levels, and creates inflammation. These disruptions in your body’s functioning have been linked to cancer, diabetes, heart disease, depression, and dementia, just to name a few. So if a proper diet and regular exercise significantly reduce your risk of dying, then why don’t people just eat healthier and exercise more?

Let’s place diet on the backburner today and focus primarily on exercise. While it’s easy to make blanket statements, such as most people are lazy or lack the commitment necessary to effect longstanding changes, those answers are much too simple. While that may be true for some, others are burdened by medical problems, genetic predispositions, and/or chronic pain that prevent them from regularly engaging in physical activity. Although the following solution is definitely not the first option that people turn to (nor is it the appropriate option for everyone), there are now a number of surgical interventions for weight loss, certain chronic pain syndromes, and physical limitations secondary to essential tremor and Parkinson’s disease. Even if you qualify for surgery, however, it’s important that you realize that surgery is usually NOT a quick or perfect fix. For instance, a gastric bypass procedure has an approximately 70% success rate for short-term weight loss but only a 50-60% success rate for long-term weight loss. The big question is: Who is most likely to have a successful surgery outcome?

If your health insurance plan has agreed to cover the costs of a procedure, then you’ve probably already spent time with your physician in an attempt to treat your condition non-surgically. During this time, your physician has likely determined, at least to some extent, whether you would be a good candidate for the procedure. But sometimes more information is needed or required to better determine your chance of success. That’s where a psychologist comes in. Oftentimes, people feel somewhat confused when they are referred to a psychologist for a pre-surgical evaluation. Understandably so, they want to know the reason for this referral and what is involved in the evaluation! These are valid questions that deserve straightforward answers. The reason for a pre-surgical evaluation is, quite simply, to assess risk. Using gastric bypass as an example again, insurance companies want some reassurance that your surgery has a high chance of being successful before they commit to covering this $20,000+ procedure. What a pre-surgical evaluation entails, however, may vary somewhat depending on the procedure that you are requesting.

Every pre-surgical evaluation requires a comprehensive understanding of your history. Although this is primarily centered on your medical history- including current and past health conditions, medications that you’ve been prescribed, and any procedures that you’ve undergone previously- information about your family history, psychiatric history, and even educational history is typically elicited. We want to know how knowledgeable you are about the specific procedure that is being planned for you, your expectations of the results, and your level of support should you require assistance. We also want to know how knowledgeable you are about the possible risks. For some procedures- such as Deep Brain Stimulation (DBS) surgery for the relief of tremors- information about your cognitive functioning is indicated as well. While the effects of anesthesia can affect just about anyone, older individuals (and particularly those with cognitive impairment or frank dementia) are at higher risk of suffering from long-term difficulties and complications.

While psychologists are usually asked to provide “clearance” prior to a patient’s surgery, our job is neither to deny you the procedure nor blindly grant our approval. Over the course of a pre-surgical evaluation, our main role is to identify your specific risk factors and suggest interventions that could increase the likelihood of your success. Without going into great length or detail, these interventions could include referrals to medical specialists, recommendations for support groups, and/or suggestions for various types of therapies. The bottom line is that most psychologists are in a helping profession because they want to help! So please don’t hesitate if your physician refers you for a pre-surgical evaluation. The sooner that you start the process, the closer you will be to achieving your desired results.

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