Preoperative Evaluation: Additional Consults
If you suffer from known heart disease, it will
be necessary to have a cardiac evaluation prior to bariatric
surgery. Similarly, if you have cardiac risk factors,
such as age over 40, diabetes, or a strong family history,
you will need to get your cardiac health evaluated prior
to bariatric surgery.
When you meet with a cardiologist, he
or she will take a full medical history and perform
a physical examination. You will need to have an EKG,
or electrocardiogram, which is quickly done in the office.
Many patients will undergo a stress test to see how
the heart functions when under stress. If the stress
test is positive then additional workup may be required.
Many obese individuals have sleep apnea. This
is a condition where fatty tissue in the neck compresses
your airway at night, resulting in such severe snoring
that you stop breathing for a short period. This episode
(called an "apnea") will usually wake you
up so that you start breathing again. However, these
frequent awakenings mean that you never get a full night's
Patients with sleep apnea tend to have
trouble sleeping and feel poorly rested in the morning.
They are often irritable or sleepy during the day, and
may eSven fall asleep while working or driving.
Sleep apnea can be detected by an overnight
sleep evaluation, also called polysomnography, or a
sleep evaluation. If your surgeon feels that you may
have sleep apnea, you will be asked to have a sleep
study. If the study shows that you do have sleep apnea,
this can be treated with a special breathing mask, known
as CPAP or BiPAP, that you wear at night.
For more information about sleep apnea
and polysomnography, please visit the Mount Sinai Center
for Sleep Medicine's web site: NYsleep.com
If you have asthma or some other known pulmonary
disease, you will be asked to meet with a pulmonologist,
or lung doctor, prior to surgery. The pulmonologist
may request additional studies, such as pulmonary function
testing, or PFTs. In PFTs, you breath into a machine
which measures the size and rate of your breaths. This
can give us very helpful information about the state
of your lungs.
Q. I've heard that
every bariatric patient needs to have an endocrine
evaluation to make sure that there is no hormonal
reason for their obesity. Does this mean that
I need to see an endocrinologist before surgery?
A. All patients will have a thyroid hormone
level checked prior to surgery, since hypothyroidism
(low thyroid level) can cause obesity. However,
this is a simple blood test that does not require
a formal consultation with an endocrinologist.
If you have a more serious endocrine problem,
such as severe diabetes or Cushing's disease,
you will be asked to consult with an endocrine
specialist before being considered for surgery.