Bariatric Times - February 2009 - (Page 9) Bariatric Times • February 2009 Practice Management Perspective 9 Referral base. Build a referral base of qualified board-certified plastic surgeons. In my experience, there is a significant aesthetic difference in postoperative results from not only procedures performed by board-certified plastic surgeons, but also those who have had specialized training or extensive experience in operating on individuals with massive weight loss. Make sure you have seen the postoperative results of a surgeon prior to your recommendation. Educate. Please educate your patients on the importance of finding a qualified surgeon. It may be beneficial to have referral cards for them to help facilitate the consult. Obviously, qualifications are the most important consideration, but there are commonly variations of surgical fees. Unfortunately, most insurance companies do not cover reconstructive surgery. Panniculectomies may be covered by insurance for medical reasons, but symptoms of the side effects must be documented at each followup appointment, including any rashes, ulceration, dermatitis, infections, and balance issues from hanging redundant skin, for example. There are several opportunities that your program can provide to facilitate patient education. One is to invite a plastic surgeon whom you have worked with to a support group meeting. This gives the patients an opportunity to get educated in a non-intimidating way. Another is to offer a plastic surgeon the opportunity to write an article for your program newsletter. It may also be beneficial to coordinate an inservice for your program staff from the surgeon or surgeons you have identified as qualified to be a referral for your patients. Always make sure you have seen and have been satisfied with the preoperative preparedness, postoperative care, and results of the surgeon before they become a referral from your program. Your program fitness coordinator and clinical staff should reinforce the importance of exercise so the individual preparing for reconstructive surgery understands that achieving good physical condition plays a role in maximizing their surgical outcomes. Being in good physical condition helps the patient recover from the procedure better. A healthy body composition can maximize their aesthetic outcome both short and long term. Reinforcing optimal nutrition. Doing this is key for proper healing. The program nutritionist should continue to emphasize the long-term commitment to proper nutrition, hydration, and vitamin supplementation. Adequate protein is important for wound healing, which is imperative after reconstructive surgery for a good postoperative result. (The next section on nutrition will elaborate on this in more detail.) Iron supplementation before surgery should be considered for the individual undergoing an abdominoplasty, for instance, since blood loss is not unusual. The basic preoperative laboratory assessment, including prealbumin, hemoglobin, iron, calcium, magnesium, and phosphorus should be considered.3 Psychological support. Lastly, but extremely important to patient care, is the role of psychological support. A consult with the program psychologist can be extremely valuable. A preoperative consult may help experts evaluate the expectations (both realistic and unrealistic) the patient holds with regards to the surgical outcome. It goes without saying that identifying the possible misconceptions or unrealistic expectations preoperatively can help prevent a lot of misery for everyone postoperatively. Many postoperative bariatric patients are probably highly motivated to undergo body contouring. High levels of motivation may not equate with psychological appropriateness. It is extremely important to match the patient’s expectations with potential outcomes and rule out body http://www.obesityeducation.com/ICSSG http://www.obesityeducation.com/ICSSG
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