Autistic bariatric patients and psychological clearance

[Frustr8 7,886]

Ooh crying in front of her wasn't good maneuver- now she can write "Emotionally Upstable". You should have made a list of these points so you could refute each step she used. High Calorie count? Show the steps you are taking to solve this. What you tapering down, what you have stopped. Not Ready?- then tell me what steps I need to take to achieve This Goal. We are not people dealing in gradients, we do not accept shades of grey as much as definate black versus white. Check how long your already passed specialist consults are valid for? I had to repeat all mine for program # 1 twice because I had let over a year elapse between leaving and re- entering the program ; hate for that to happen to you- then I was denied because apparently I did not make him feel " Warm and Fuzzy" denied because of feelings instead of any logic,Well I am well rid of HIM , second program was more what. I needed anyway and I am GLAD I went there.
Perhaps a bariatric consoulerto help you work through the steps, you have done so much toward this to be stopped. Maybe your family needs to attend a bariatric meeting or 2, that way they will see commitment and Right purpose on YOUR part, not a passing whim but something you are trying to earn the right to.
You couldn't have called November 1st because it is only the middle of September, did you possibly mean September 1st?
Go ahead and do your sleep Study, might turn out you'll think better after wearing a C-Pap, and there is a chance maybe you won't require one. Of so, at least you'll know. But THAT might be a valid point to bring up with the surgical office, that YOU are trying. for surgery to cure or at least diminish breathing and sleeping difficulties- maybe they will give you CREDIT for attempting change. Make a list of positive ways you are going to lower down your calorie count to an level they will okay- maybe work with a dietician that understands Bariatrics and preparation for it- NOT all DO.
Can you work with a Bariatric friendly person to help re- prepare you? Just a few observations and suggestions, I myself have started going to a Bariatric Support Group meeting in my town, my own Surgical Center had only evening meetings and I really felt welcomed and hi gained new approaches even at this post- surgical state and a few more people going through with this challenge in Life.
But Vent if you like, this IS A PROFOUND CHANGE TO ACHEIVE- not easy, sometimes not quick but if You Can Stick It Out- So So Worth it All!

[Darktowerdream 420]

I’d find it upsetting that it’s a therapist deciding if you can handle the surgery and not a surgeon and nutritionist. A bariatric nutritionist would be better at setting the pre surgery goals to work on calorie intake and carb intake. I had letters from my pcp about my efforts at low carb, low calorie approach and a letter from a endocrinologist about metabolic disorders. But never would I trust a therapist to decide what’s best. It’s that initial pre op diet that is the true test of how you will function after surgery. I didn’t have support, I’m living with my mom. She is much smaller than me and never had food issues. I can’t say how long it took me to fight sugar and carb addiction many years back and yet I ended up back where I began. It’s a hard road but I think you need an advocate to help navigate the system and get on the right track. Start with gradually lowering calories and carbs and cutting sugar. Look for healthier alternatives.

I wish I had better to say. My first visit with a bariatric surgeon was a train wreck and yes I had a breakdown and knew it wasn’t going to happen. The doctor then refused to help me. I kept pushing my pcp to record my efforts and finally saw another endocrinologist who recommended Cleveland clinic where the process was much smoother and the staff their extremely helpful.

it wouldn’t have happened without their help. It’s not an easy road. Though they do need to know you won’t fall back to bad habits. I don’t think a therapist is as good a support system as a bariatric care team with a nutritionist.

ugh. I’m sorry im too tired to make sense today. I’m sad that you felt so bad during the appointment and couldn’t get your words across. I deal with that all the time and have to try to push down as hard as I can if I start crashing into a total meltdown. It’s not easy. But I think at some point you will get where you need to be. Try to seek out an advocate. You need a bariatric care team working to help you through this fight.

[cajunredpanda 95]

7 hours ago, Frustr8 said:

Ooh crying in front of her wasn't good maneuver- now she can write "Emotionally Upstable". You should have made a list of these points so you could refute each step she used. High Calorie count? Show the steps you are taking to solve this. What you tapering down, what you have stopped. Not Ready?- then tell me what steps I need to take to achieve This Goal. We are not people dealing in gradients, we do not accept shades of grey as much as definate black versus white. Check how long your already passed specialist consults are valid for? I had to repeat all mine for program # 1 twice because I had let over a year elapse between leaving and re- entering the program ; hate for that to happen to you- then I was denied because apparently I did not make him feel " Warm and Fuzzy" denied because of feelings instead of any logic,Well I am well rid of HIM , second program was more what. I needed anyway and I am GLAD I went there.
Perhaps a bariatric consoulerto help you work through the steps, you have done so much toward this to be stopped. Maybe your family needs to attend a bariatric meeting or 2, that way they will see commitment and Right purpose on YOUR part, not a passing whim but something you are trying to earn the right to.
You couldn't have called November 1st because it is only the middle of September, did you possibly mean September 1st?
Go ahead and do your sleep Study, might turn out you'll think better after wearing a C-Pap, and there is a chance maybe you won't require one. Of so, at least you'll know. But THAT might be a valid point to bring up with the surgical office, that YOU are trying. for surgery to cure or at least diminish breathing and sleeping difficulties- maybe they will give you CREDIT for attempting change. Make a list of positive ways you are going to lower down your calorie count to an level they will okay- maybe work with a dietician that understands Bariatrics and preparation for it- NOT all DO.
Can you work with a Bariatric friendly person to help re- prepare you? Just a few observations and suggestions, I myself have started going to a Bariatric Support Group meeting in my town, my own Surgical Center had only evening meetings and I really felt welcomed and hi gained new approaches even at this post- surgical state and a few more people going through with this challenge in Life.
But Vent if you like, this IS A PROFOUND CHANGE TO ACHEIVE- not easy, sometimes not quick but if You Can Stick It Out- So So Worth it All!

I'm afraid I might've totally messed it up by doing that. I think there's one other counselor at the clinic but I'm afraid to switch at this point. Probably need to. Just don't know if it's okay to call the receptionist and go "hey, can I change to ____?" I just want my parents to come to a meeting or two with me but they don't seem to want to go. When they do take me to meeting since I can't drive they just drop me off and go to McDonald's. Then they'll tell me everything I'm doing wrong and nothing I'm doing right. That I'll be like the people on My 600 Pound Life that get the surgery and then go straight back to eating copious amounts of food within a month. My brother compares himself to me because he's been losing more weight than me despite me telling him that males lose fat easier than women and yadda da. You're right though, I may need to write down refutes.

(I meant to say that my initial interaction with the clinic was November 1, 2018. Sorry for the confusion.)

2 hours ago, Darktowerdream said:

I’d find it upsetting that it’s a therapist deciding if you can handle the surgery and not a surgeon and nutritionist. A bariatric nutritionist would be better at setting the pre surgery goals to work on calorie intake and carb intake. I had letters from my pcp about my efforts at low carb, low calorie approach and a letter from a endocrinologist about metabolic disorders. But never would I trust a therapist to decide what’s best. It’s that initial pre op diet that is the true test of how you will function after surgery. I didn’t have support, I’m living with my mom. She is much smaller than me and never had food issues. I can’t say how long it took me to fight sugar and carb addiction many years back and yet I ended up back where I began. It’s a hard road but I think you need an advocate to help navigate the system and get on the right track. Start with gradually lowering calories and carbs and cutting sugar. Look for healthier alternatives.

I wish I had better to say. My first visit with a bariatric surgeon was a train wreck and yes I had a breakdown and knew it wasn’t going to happen. The doctor then refused to help me. I kept pushing my pcp to record my efforts and finally saw another endocrinologist who recommended Cleveland clinic where the process was much smoother and the staff their extremely helpful.

it wouldn’t have happened without their help. It’s not an easy road. Though they do need to know you won’t fall back to bad habits. I don’t think a therapist is as good a support system as a bariatric care team with a nutritionist.

ugh. I’m sorry im too tired to make sense today. I’m sad that you felt so bad during the appointment and couldn’t get your words across. I deal with that all the time and have to try to push down as hard as I can if I start crashing into a total meltdown. It’s not easy. But I think at some point you will get where you need to be. Try to seek out an advocate. You need a bariatric care team working to help you through this fight.

I'm confused why what my nutritionist said isn't mattering. I got cleared on that end in early August. She said that my food intake was overall good. I'm making changes and as long as I keep making them that I'm doing great. If anything my Fiber was too low. That and to check food labels for fat and sugar intake.

Meanwhile my psych is telling me that the more stressed I am the more I eat, so you need to do something about that. She nearly got on me for eating cake on my mom's birthday and I had to clarify that it was one slice and I didn't eat any leftover cake. Heaven forbid I want to Celebrate. I keep feeling like maybe I should find someone else but I don't know if I can. There's one other psychologist in the clinic I believe but I don't know how to switch or if I can. This is the only clinic I can really use.

My clinic has a Facebook group and list of people that had the surgery that I can talk to. Do you think I should ask one to be my advocate?

[Darktowerdream 420]

8 hours ago, cajunredpanda said:

I'm afraid I might've totally messed it up by doing that. I think there's one other counselor at the clinic but I'm afraid to switch at this point. Probably need to. Just don't know if it's okay to call the receptionist and go "hey, can I change to ____?" I just want my parents to come to a meeting or two with me but they don't seem to want to go. When they do take me to meeting since I can't drive they just drop me off and go to McDonald's. Then they'll tell me everything I'm doing wrong and nothing I'm doing right. That I'll be like the people on My 600 Pound Life that get the surgery and then go straight back to eating copious amounts of food within a month. My brother compares himself to me because he's been losing more weight than me despite me telling him that males lose fat easier than women and yadda da. You're right though, I may need to write down refutes.

(I meant to say that my initial interaction with the clinic was November 1, 2018. Sorry for the confusion.)

I'm confused why what my nutritionist said isn't mattering. I got cleared on that end in early August. She said that my food intake was overall good. I'm making changes and as long as I keep making them that I'm doing great. If anything my Fiber was too low. That and to check food labels for fat and sugar intake.

Meanwhile my psych is telling me that the more stressed I am the more I eat, so you need to do something about that. She nearly got on me for eating cake on my mom's birthday and I had to clarify that it was one slice and I didn't eat any leftover cake. Heaven forbid I want to Celebrate. I keep feeling like maybe I should find someone else but I don't know if I can. There's one other psychologist in the clinic I believe but I don't know how to switch or if I can. This is the only clinic I can really use.

My clinic has a Facebook group and list of people that had the surgery that I can talk to. Do you think I should ask one to be my advocate?

I really think it would help you to have an advocate. I find it wrong for the

8 hours ago, cajunredpanda said:

I'm confused why what my nutritionist said isn't mattering. I got cleared on that end in early August. She said that my food intake was overall good. I'm making changes and as long as I keep making them that I'm doing great. If anything my Fiber was too low. That and to check food labels for fat and sugar intake.

Meanwhile my psych is telling me that the more stressed I am the more I eat, so you need to do something about that. She nearly got on me for eating cake on my mom's birthday and I had to clarify that it was one slice and I didn't eat any leftover cake. Heaven forbid I want to Celebrate. I keep feeling like maybe I should find someone else but I don't know if I can. There's one other psychologist in the clinic I believe but I don't know how to switch or if I can. This is the only clinic I can really use.

 My clinic has a Facebook group and list of people that had the surgery that I can talk to. Do you think I should ask one to be my advocate?

I really think you might benefit from an advocate. I don’t think the psych is being fair to you. I live with my mom but my having surgery is not reliant on her support. While it’s true, other people’s eating habits can effect your own this shouldn’t be a deciding factor. It’s also unfair for her to shame you for having a piece of cake. Change takes time and surgery will be a tool to help with change.

My first surgeon appointment went horribly for me. Like your psych, he talked at me and made assumptions instead of listening. I could barely conceal my utter and total meltdown when I left the office. It was the combination of constantly telling my pcp about my weight loss efforts and my finding a better endocrinologist (the first endocrinologist was also a disaster) but the second endocrinologist listened to my history and medical issues and referred me to Cleveland Clinic, she said the whole bariatric surgery process was easier and she ended up being right.

I know some require psych clearance and yes you need to do the head work, dealing with eating habits, cutting carbs and sugar, etc. but you are working at it and it’s that pre surgery diet that is what prepares you for what comes after.

For me I had already fought hard some years ago to deal with sugar and carb addiction due to metabolic disorders. Even with my strict changes in my eating habits I ended up back to square one with my weight. I got to where I knew I needed extra help of bariatric surgery.

I wish I had better answers but keep fighting. Try to find an advocate and if possible see another psych and try to write down exactly what your goal is with bariatric surgery and the steps you have taken so far. I know it’s hard when options are limited. See if you can talk to the nutritionist or have an advocate talk to them and ask why the psych is clocking you from getting clearance for surgery and if they have the right to do that to you. Someone in the bariatric surgeons office might even be able to help you with the process.

[froufrou 678]

I am so sorry to hear about your latest experience!! I am utterly appalled at this psychologist - she is placing impossible demands on you. You are doing everything right! If you were able to eat perfectly, then you wouldn't be needing the surgery. I don't blame you for breaking down in front of her.

Please, please find yourself a different psych to see. She sounds dreadful. Also, can one of your family members or friends go with you to advocate for you next time too? God, I wish I was there... I'd come with you in a heartbeat. I hate that you have been through this.

[froufrou 678]

@cajunredpanda - I don't know if you have had an experience with ARC, but I have used them when I needed someone to come to my daughter's IEP meetings at school. It looks like they may do medical advocacy too, and from my experience their advocacy is free. Maybe you can give them a call? https://thearc.org/policy-advocacy/health-care/

https://thearc.org/find-a-chapter/

[Stella S 612]

I am not sure where on the spectrum you fell. The psychological role is limited to rational expectations, ability to follow steps and fair judgement you could ask the surgeon if an outside Psych could be used. It is a way the clinic mitigates liability. If the psych has no training or experience with autism then the psych is practicing outside expertise You would be well within your rights to ask that particularpsych to obtain a consultation. Failure to do so may be considered malpractice or negligence on the psych part. An argument could be made that some individuals on the spectrum would have an increased rigid adherence to the rules because of a need structure. I would not worry too much about the tearful moment - The power and balance is real and for a very brief time you saw a future you’ve worked hard to reach taken away from you. Take some breaths refocus and meet again. Having an advocate within the room is totally acceptable this is something you are contracting for and short this person is working for you to help you reach success. Try reframing it so you can take the power back and meet the requirement to be able to follow a plan. I was private pay so did not need a mental health clearance but also Emma psychologist by trade - education

[Stella S 612]

One more thing switching to a different psychologist at the same clinic does not change what’s already written in your medical record. You may be able to change but the other counselor will have access to the notes if it’s in the same clinic. You are also within your rights to request a copy of your medical record which they have to provide to you unless they can prove it would be harmful to your well-being and make copies available within 30 days in the United States. I absolutely hate that the medical system is for profit in this country.

[cajunredpanda 95]

20 hours ago, Darktowerdream said:

I really think it would help you to have an advocate. I find it wrong for the

I really think you might benefit from an advocate. I don’t think the psych is being fair to you. I live with my mom but my having surgery is not reliant on her support. While it’s true, other people’s eating habits can effect your own this shouldn’t be a deciding factor. It’s also unfair for her to shame you for having a piece of cake. Change takes time and surgery will be a tool to help with change.

My first surgeon appointment went horribly for me. Like your psych, he talked at me and made assumptions instead of listening. I could barely conceal my utter and total meltdown when I left the office. It was the combination of constantly telling my pcp about my weight loss efforts and my finding a better endocrinologist (the first endocrinologist was also a disaster) but the second endocrinologist listened to my history and medical issues and referred me to Cleveland Clinic, she said the whole bariatric surgery process was easier and she ended up being right.

I know some require psych clearance and yes you need to do the head work, dealing with eating habits, cutting carbs and sugar, etc. but you are working at it and it’s that pre surgery diet that is what prepares you for what comes after.

For me I had already fought hard some years ago to deal with sugar and carb addiction due to metabolic disorders. Even with my strict changes in my eating habits I ended up back to square one with my weight. I got to where I knew I needed extra help of bariatric surgery.

I wish I had better answers but keep fighting. Try to find an advocate and if possible see another psych and try to write down exactly what your goal is with bariatric surgery and the steps you have taken so far. I know it’s hard when options are limited. See if you can talk to the nutritionist or have an advocate talk to them and ask why the psych is clocking you from getting clearance for surgery and if they have the right to do that to you. Someone in the bariatric surgeons office might even be able to help you with the process.

I'm sorry you had to deal with that too. I'm great at losing 30 pounds by myself but then something happens and I regain everything and more. I was hoping to have sleeve as an additional tool to get me over the hump and keep going. Obviously I wouldn't know how my restriction would be like until after surgery, though. I've mentioned this to my psych and she was still like "I'm not risking what you'll do if you don't have restriction etc so we need to keep going." Sigh... I'm planning on calling the clinic tomorrow and see if I can at least contact my nutritionist. My NUT is a sweetheart and I felt comfortable talking to her.

13 hours ago, froufrou said:

I am so sorry to hear about your latest experience!! I am utterly appalled at this psychologist - she is placing impossible demands on you. You are doing everything right! If you were able to eat perfectly, then you wouldn't be needing the surgery. I don't blame you for breaking down in front of her.

Please, please find yourself a different psych to see. She sounds dreadful. Also, can one of your family members or friends go with you to advocate for you next time too? God, I wish I was there... I'd come with you in a heartbeat. I hate that you have been through this.

12 hours ago, froufrou said:

@cajunredpanda - I don't know if you have had an experience with ARC, but I have used them when I needed someone to come to my daughter's IEP meetings at school. It looks like they may do medical advocacy too, and from my experience their advocacy is free. Maybe you can give them a call? https://thearc.org/policy-advocacy/health-care/

https://thearc.org/find-a-chapter/

Thank you for the validation. I seriously felt like I was going crazy. I'm going to start with seeing the NUT again and maybe switching to another psych if I can help it. If that doesn't work then advocate is an option.

7 hours ago, Stella S said:

I am not sure where on the spectrum you fell. The psychological role is limited to rational expectations, ability to follow steps and fair judgement you could ask the surgeon if an outside Psych could be used. It is a way the clinic mitigates liability. If the psych has no training or experience with autism then the psych is practicing outside expertise You would be well within your rights to ask that particularpsych to obtain a consultation. Failure to do so may be considered malpractice or negligence on the psych part. An argument could be made that some individuals on the spectrum would have an increased rigid adherence to the rules because of a need structure. I would not worry too much about the tearful moment - The power and balance is real and for a very brief time you saw a future you’ve worked hard to reach taken away from you. Take some breaths refocus and meet again. Having an advocate within the room is totally acceptable this is something you are contracting for and short this person is working for you to help you reach success. Try reframing it so you can take the power back and meet the requirement to be able to follow a plan. I was private pay so did not need a mental health clearance but also Emma psychologist by trade - education

7 hours ago, Stella S said:

One more thing switching to a different psychologist at the same clinic does not change what’s already written in your medical record. You may be able to change but the other counselor will have access to the notes if it’s in the same clinic. You are also within your rights to request a copy of your medical record which they have to provide to you unless they can prove it would be harmful to your well-being and make copies available within 30 days in the United States. I absolutely hate that the medical system is for profit in this country.

I have Aspergers. I had disability assistance along with therapy for depression and anxiety from Kindergarten to college (note: the therapy started in high school). My psych claims that she has approved people "lower functioning" than me so I'm wondering what did they do "right" and I'm doing "wrong?" HIPPA prohibits specific information about the others but still, that's a serious question. Everyone else has been willing to work with me including my surgeon during our initial consultation. Heck, my normal therapist approves of my surgery plans and thinks that even with the new lifestyle changes that losing the weight would overall help my mental state. The problem is that she has no bariatric experience so her thoughts on the subject are considered moot.

You're right about the new psychologist having my records. Maybe having someone new will make it easier to talk since I have to re-say everything. Who knows. I really want this surgery; I wouldn't be struggling with this if I didn't want it.

[JessLess 1,163]

@cajunredpanda, your surgeon wants to do the surgery on you. The psych test is really just to make sure you can follow the directions to safely get the surgery, which it sounds like you can. I also had depression and anxiety and all the psychologist wanted to know was that I was in treatment and would continue it post-surgery. You live with your parents and I live with my husband. He went from very unsupportive to highly supportive after he saw how smoothly everything went and how happy I am now. So some people's opinions do change.

I don't see how being autistic would be a factor as long as you can follow your plan, which it sounds like you can. Anyone who is surprised someone would cry or have a panic attack in such a stressful situation probably needs more training.

So. I would talk to your surgeon or practice manager and explain what has happened and ask for a psychologist with more experience with autism, or if you can use your own. If they are not helpful, I would find another program. Good luck!!!

[froufrou 678]

2 hours ago, JessLess said:

@cajunredpanda

So. I would talk to your surgeon or practice manager and explain what has happened and ask for a psychologist with more experience with autism, or if you can use your own. If they are not helpful, I would find another program. Good luck!!!

Yes, I second this.

[Bastian 458]

On 9/19/2019 at 5:59 AM, cajunredpanda said:

I wish I could say that I was cleared, but I wasn't. I admittedly started sobbing when I realized she wasn't going to clear me... this time. She said that I'm making good progress. I'm just not "ready" yet. Her main concerns were that my family isn't very supportive (I live with them) and that my daily calorie range is too high (I'm eating between 1200-2000 a day). I didn't tell her that I had support on the internet (plus my LDR) because, well, I was too upset. I even had a panic attack and had to calm down before leaving. It was bad, y'all. The pyschologist is going to see if there are other support groups besides the hospital one that I can participate in while I'll try to focus on eating better. I'm eating better overall; it's just not "there."

The main reason I was upset is because I'm supposed to have cardiac and pulmonary clearance a month before surgery. I had my pulmonary clearance over two weeks ago. I also didn't have to see the nutritionist and exercise trainer until surgery unless something came up to delay it. Add that I now have a sleep study next week and I'll be pushed back yet again. I feel like I'm starting at square one again. I called the clinic November 1st and it appears I won't have surgery until over a year after starting my journey it seems. Sorry for the mini rant. That's just how much this clearance at this time mattered/s to me.

Hold on a minute why is a psychologist telling you how to eat BEFORE you have had surgery? Why would you be trying to have 100g Protein a day pre-surgery?

Fantastic that you are eating better but I don't understand why she is telling you how to eat it isn't her speciality is it, wouldn't a dietician be doing that and your calorie range is good.

Stick with the high protein because it fills you up and try and fill up with lots of veggies rather than bread Pasta rice potatoes

Amazing how much you have lost already monitoring your intake, BE PROUD of yourself.

I'm so sorry she didn't approve you, that sux BUT it sounds to me like it won't take much to get her to approve you the next time you go through the process. Big virtual hugs x

[cajunredpanda 95]

So I contacted my program manager. She said that she'll talk to the psychologist. She did say that 2000 is a high max but that 1800 or lower should be fine. I also got contact info for people I can talk to regarding surgery itself (including our Facebook group, which I have been interacting with). I still have to go to the psych appointment October 1st. I hope I didn't do anything wrong; I'm super nervous about it.

[november11 970]

@cajunredpanda so sorry to hear this . it sounds like you are doing all the right things....Just hang on and don't give up

[cajunredpanda 95]

I went to my appointment on October 1 but for some reason my appointment wasn't in the computer. I had the sticky note to prove that it was set up. Hopefully it was just a computer error. I see her again this Tuesday. I'm nervous about what it'll entail.

Had a sleep study done and it was determined that I don't have sleep apnea. What a relief! Yet another thing pushing back my date is the last thing I need. Had to restart clearances for insurance reasons because of the delay. Nutrition thought that my logs were fine and liked I've been losing weight, so I'm still cleared on that end. I wish that that was enough.