Psych Hold

[almosthome 91]

My WLS journey began several years ago, and everything has finally fallen into place for it: easy insurance requirements, a flexible schedule this winter (thesis writing), etc. I've timed my appointments with the hope that I can have surgery in mid/late-February, giving myself two months of recovery time before graduation and travel for job interviews.

Last week, though, I had a psych eval and mentioned that about 5 years ago (mid-20's) I had issues with frequent bingeing (2-3 times a week). I explained that since then, high-junk-food-consumption days have been conscious decisions that occur maybe once every two months (like on my birthday), especially since I know there won't be the same opportunities after surgery. The foods I eat regularly are healthy, and I allow myself a small treat daily to stave off cravings. The psych evaluator finds it concerning that I think it's okay to have junk food days and says she won't clear me for surgery until I can prove I've started receiving therapy and abstained from naughty days for the next 6 weeks. She said she is not so much worried about the potential for short-term failings but rather my ability to maintain loss years down the road.

I don't mind seeing a therapist and am sure it can help me prepare for future psychological challenges related to WLS. But I have already done a lot of soul-searching, understand my present choices, and am committed to following the pre-/post-op requirements for safety & success. What irritates me is that she won't clear me for 6 weeks even if the surgeon gives a green light. That means my pre-approval can't even be submitted to insurance until late February. The evaluator said she 'knows it must seem inconvenient'.

Have any of you had similar experiences with the psych eval? Did it delay your surgery, or were you able to work it out some other way? Any advice? Thanks!

[belunos 93]

The worst part is, at least for me, the psych stuff wasn't even for insurance. It was just a hoop to pass through for the whole 'program' at the center, because I was using insurance. I was told that If I was self pay I could have had the surgery within a month without this whole rigmarole!

Anyway, my eval said that I lacked motivation. Someone from the surgery center called me about it, but I said I had already talked to the surgeon about my motivation, and that seemed to be good enough for them.

I might maybe talk to your surgery center about it. I don't know if they actually have to follow the psych recommendations.

[BigGirlPanties 957]

We all have the problem of giving too much information... I don't see the real problem with what you said, you were being honest...did you speak with her about your concerns for a February surgery date and see if there is something that you can work out? Seems a bit ridiculous that they have that kind of power; but I know they do...because I was told I had to pass the eval as well when I had my surgery...and part of it was a "test" on a computer that took almost an hour ... which was stupid, since anyone with a brain would know how to answer those things "correctly"...

I also had to attend a nutritional class with an addition counselor...during the class, she kept telling one guy he was SOOOO not ready for surgery; and I had to agree with her, the things he was saying was RIDICULOUS for someone with a weight problem... in the end, it's all worth it if you do it the right way!

Good luck

Edited January 15, 2014 by BigGirlPanties

[Fluffnomore 1,235]

I may state something unpopular here, but I don't think the psych evaluation is a bad idea.

I can share three different stories.

I flew through it. That is because although I was obese enough to qualify for surgery, I have never had an eating disorder or a tendency to binge. It was very cut and dried.

My close friend, who has a history of bulimia, lied her way through it. She is very smart and knew exactly what they were after. She passed the first time out.

My husband, who has a history of bulimia and binge eating, told the truth. He did not pass the first time but did pass the second time.

Of the three of us, my opinion is that my husband is the least ready for the surgery. We are still fighting the insurance for it. My sense is that he will get it, eventually. But it will take some time.

My friend, who got the surgery 4 months before me, has had some really tough realizations since being sleeved. Over the summer she called and said, "I was not prepared for the fact that I have to actually process through my feelings." I think this hits us all on some level, but it was really gnarly for her. She had conquered the bulimia a long time before but not "stuffing" her feelings. She has also had a significant slowing in her weight loss (way more than she or the doctor expected) and has been one of those patients who has to exercise 7 days a week, and track maniacally to lose each pound.

And even though I didn't have the obvious food issues (the big ones) I still have had to adjust my thinking to a new normal and come up with certain coping strategies, etc. I would not work with the psych that my practice uses but I think it's important that we all really understand that this is as much a head game as a physical one. More so, really.

[soflatechie 16]

Agreed. This is a huge decision. The sleeve is irreversible. You want to go in with your eyes wide open. The psych needs to make sure you know and understand what you are getting yourself into.

Real world example - I knew someone who failed the psych years ago. What did he do? He went to south America where the requirements were easier. About a year after the surgery he started sabotaging his progress by grazing with carbs and alcohol. Gained the weight back.

It is tough if psych says no but I think it is important. I am on my pre op diet and already I am noticing how I have previously used food to comfort me during stressful times. Just had my pre op visit and it was a little stressful so after the visit the first thing I thought about is how normally I would just go to the hospital cafe for a snack and a coffee to deal with it. Of course I can't now. Amazing how the mind works.

We need to deal with our minds or this won't work.

May not be what the op wants to hear but I mean no offense, just my .02

[truck8595 64]

Hi all, new here!

As someone still going through the "pre" process (just waiting for my insurance approval & surgery date), I can add a couple thoughts on the psych eval.

I am someone who likes his alcohol. A lot. Not being able to drink when or as much as I want to going forward, well, that's going to be rough. Maybe I disclosed my love of rum 'n cokes a bit too much during my psych visits, but it triggered a concern with them that I have a higher likelihood to hit the bottle harder while coping with not being able to eat like I used to. "Addiction Transfer" I believe it's called. I was really scared this was going to set me back as far as them wanting to see me jump through more hoops, etc, but luckily for me, they just told me that I will need to see the psych a couple times post-surgery to see how I am dealing and making sure I'm not boozin' (I don't intend to, this is too big a deal).

That all said, I am so glad such a community exists, and I look forward to becoming a successful sleever. Keep up the good work everyone, and keep being the inspirations that you are!

~Truck

[almosthome 91]

For all the "TL;DR" responders, I wrote in the original post that I don't at all mind going through therapy and do see it as valuable. Please don't assume I'm taking this lightly. My issue is the evaluator says all she really wants is proof I've established therapy yet still plans to make me wait 6 weeks. She herself said the 6-week no-naughty assignment can't prove anything, just short-term compliance (something I have already been doing since November). The problem is timing, not recklessness. I talk to the surgeon on Friday and will ask him about it, too. Thank you!

[soflatechie 16]

I meant no offense by my post. Wish you the best in your surgery...

[almosthome 91]

None taken! Looking back, my reply reads a little harsh; sorry about that. I know everyone here is just trying to help, and I genuinely appreciate all the wisdom and stories.

[Fluffnomore 1,235]

TL; DR? I read your post. I was giving you three examples of actually going through it. Again, not meant to be harsh. And I agree the timing sucks. We really needed my husband to get in in December. Now assuming he gets approved eventually he will need to wait until June because of his work schedule. And maybe that will ultimately help him. But it is mightily frustrating. So I get that.

Good luck.

[soflatechie 16]

No worries

I worry that this liquid diet will cause me to sound harsh as well because I am just so anxious to get this over with.

Yesterday I almost went off on one of the staff at my pre-op appointment because they said I didn't have clearance from the pulmonologist after my sleep study. Yeah, a few days from surgery and already on a liquid diet, he wanted me to go back to the pulmonologist and get clearance?

Luckily he realized I did have clearance, or my next stop would have been Dunkin Donuts! (kidding)

[account closed 20]

Just wanted to add on to what fluffnomore said (who I completely agree with). This is a major, life-changing decision. I have seen a number of people post on this forum about regretting their surgery and depression because, in their own words, they "lied [their] way through the process." You're not going to be able to have 'junk food days' anymore. Your body may not even like junk food anymore (as I've found out). That may sound great at first -easy way to diet, right? but you underestimate what that can do to you mentally if you have a history of disordered eating.

I know the timing is inconvenient, but how often in life do things happen to us when we we're ready for it? : P I don't really have an opinion on the '6 week test' but I hope you decide to take the time to seek therapy/counseling.

[TheOldMeAgain 128]

Everyone says take time to seek counseling, therapy is so helpful to you. I've sought out counseling a few times. Only once did I find it beneficial. Not everyone NEED therapy for their so called problems. Part of what's wrong with society now is everything is consider an issue that need to be dealt or help with. My psychiatrist tried to tell me I needed help with alcoholism. Based on the amount and times a month I drunk. He wouldn't take in consideration that my friends and I partied and socialized a lot. Even during weekdays. A few yrs later when asked did I need help with my drinking. I said no I never had a problem and I don't drink much now. He ignored what I said and asked did I get help. Looked skeptical when I said no I just don't go now and slowed down. First he didn't believe I could drink so much and not be an alcoholic and second if I was one that I could stop on my own. He's not the only psych doc I came across that believes that. The same goes for food and drugs. They think were all the same and one size fits all. You admit to anything that sounds like a current society problem, bang, your too damaged and unfit for _______, you have to get __ wks/months counseling first.

My sister had months of counseling. It did her no good. She didn't change her ways and don't regret surgery. A few friends of our didn't get counseling ( one lied about some things) and are doing fine by eating right and exercising. I can't wait to join them in step and Zumba classes. So passing a psych eval doesn't guarantee being ready for WLS.

[soflatechie 16]

Every one is different. We are all unique. It is true that there are those that can pick themselves up from their bootstraps and resolve their issues on their own. It is also true that not all counseling is good. I have experienced that also.

However, I will offer this.

I would say that the large majority of us are considering WLS because we have NOT been able to do it on are own. If we could, what would we be doing here?

I mean no offense, but is it reasonable for a psych to consider excessive alcohol a problem, one that could benefit from counseling? I think so. Can someone take care of it on their own? I guess so, but most do not. I have seen it time and time again.

With respect to WLS, I saw first hand an acquaintance with a habit of drinking socially swap out his food addiction with drinking and become an alcoholic after surgery.

If you are one of those that can deal with this on your own, more power to you.

But is it reasonable for a pysch to be concerned for you and ask you to get counseling, knowing that you already have an issue with food that has caused you to seek the help of others to correct it?

Absolutely!

Edited January 16, 2014 by soflatechie

[TheOldMeAgain 128]

Every one is different. We are all unique. It is true that there are those that can pick themselves up from their bootstraps and resolve their issues on their own. It is also true that not all counseling is good. I have experienced that also. However, I will offer this. I would say that the large majority of us are considering WLS because we have NOT been able to do it on are own. If we could, what would we be doing here? I mean no offense, but is it reasonable for a psych to consider excessive alcohol a problem, one that could benefit from counseling? I think so. Can someone take care of it on their own? I guess so, but most do not. I have seen it time and time again. With respect to WLS, I saw first hand an acquaintance with a habit of drinking socially swap out his food addiction with drinking and become an alcoholic after surgery. If you are one of those that can deal with this on your own, more power to you. But is it reasonable for a pysch to be concerned for you and ask you to get counseling, knowing that you already have an issue with food that has caused you to seek the help of others to correct it? Absolutely!

My point was that I didn't have an alcohol problem. I never woke up needing a drink or drunk when stressed nor met any of the other qualifications for alcoholism. Yet like the pysch doctors it sounded like it. To me it was all part of socializing and being young. Anyways bottom line IMO there is no clear way to be certain in the evaluation process to say if someone is stable or ready for WLS from only one meeting. After surgery I absolutely believe therapy would be of great help. I plan on seeking out me a new counselor. One of the friends mention cousin had WLS. She lost all her weight and was determined never to regain it again. She turned to diet pills, and alcohol to deal with not dealing with her body dysmorphia and later died of liver failure. So I know transfer addictions are real, can and do happen. I just don't believe Presurgical psychological evaluation is a indicator of being ready for WLS. Change it to post-surgical mandatory counseling.