Re: We're All Crazy, For Why Else Would We Have To Have To See A Shrink?

[Guest guest]

As a person who does psych evaluations on a daily basis, I have long opposed

the need for the type of psych evals required pre op fro WLS. I do think

that there are a couple of things that the surgeon needs to know. One is

whether or not the patient is competent to make the decision to have the

surgery and maintain the life long vigilance to avoid malnutrition. The

second is whether or not the patient has a mental health disorder that may,

at times, so cloud their judgment that they believe they do not need to

comply with the post op requirements to maintain good health.

The reason that most surgeons require the psych eval is because it is part

of the NIH guidelines for surgery. And there are a few notable cases where

the cognitive function or the mental health of the post op patent was so

impaired that they put their life at risk with non compliance.

My personal bias is that pre ops find a therapist in their own community

that they feel comfortable working with. And that each pre op make an

agreement to see that person in the event of onset of depression or great

life stress post op.

The use of the MMPI and other psychological tools for the pre op WLS is pure

nonsense. Except that if the post op patient fails to do what is needed to

stay healthy the surgeon can't be sued for this. After all, they relied on

another professional for this information. The professional literature

indicates that there is no relationship between the results of these tests

and WLS outcomes. Reliance on these rather than a thorough personal

interview with the patient is indicative of how little most surgeons know

about the mental health profession. Some of the surgeons ask for a simple

letter from a professional saying that the patient understand the surgery,

has realistic expectations regarding outcomes, has no apparent personality

issues that would impair compliance, and is able to make this decision.

Seeing a " shrink " has nothing to do with being crazy. Being depressed,

having PTSD, being under great stress, and having emotional pain happen to

people during life. Seeing a professional for these can make some sense.

Suggesting that anyone who sees a mental health professional is " crazy " is a

barbaric notion. I'm sure that you wouldn't intentionally insult the many

people on this list who seek such professional help.

in Seattle

DS 1/5/01 295# BMI 47.6

4/5/01 240# BMI 38

Dr Welker - OHSU

----- Original Message -----

> I'm not crazy; I'm just fat.

>

> Why the waste of good money seeing psychologists and

> psychiatrists before baryatric surgery? If a woman

> gets plastic surgery for a face lift or her boobs, she

> doesn't have to see a shrink beforehand.

[Guest guest]

As a person who does psych evaluations on a daily basis, I have long opposed

the need for the type of psych evals required pre op fro WLS. I do think

that there are a couple of things that the surgeon needs to know. One is

whether or not the patient is competent to make the decision to have the

surgery and maintain the life long vigilance to avoid malnutrition. The

second is whether or not the patient has a mental health disorder that may,

at times, so cloud their judgment that they believe they do not need to

comply with the post op requirements to maintain good health.

The reason that most surgeons require the psych eval is because it is part

of the NIH guidelines for surgery. And there are a few notable cases where

the cognitive function or the mental health of the post op patent was so

impaired that they put their life at risk with non compliance.

My personal bias is that pre ops find a therapist in their own community

that they feel comfortable working with. And that each pre op make an

agreement to see that person in the event of onset of depression or great

life stress post op.

The use of the MMPI and other psychological tools for the pre op WLS is pure

nonsense. Except that if the post op patient fails to do what is needed to

stay healthy the surgeon can't be sued for this. After all, they relied on

another professional for this information. The professional literature

indicates that there is no relationship between the results of these tests

and WLS outcomes. Reliance on these rather than a thorough personal

interview with the patient is indicative of how little most surgeons know

about the mental health profession. Some of the surgeons ask for a simple

letter from a professional saying that the patient understand the surgery,

has realistic expectations regarding outcomes, has no apparent personality

issues that would impair compliance, and is able to make this decision.

Seeing a " shrink " has nothing to do with being crazy. Being depressed,

having PTSD, being under great stress, and having emotional pain happen to

people during life. Seeing a professional for these can make some sense.

Suggesting that anyone who sees a mental health professional is " crazy " is a

barbaric notion. I'm sure that you wouldn't intentionally insult the many

people on this list who seek such professional help.

in Seattle

DS 1/5/01 295# BMI 47.6

4/5/01 240# BMI 38

Dr Welker - OHSU

----- Original Message -----

> I'm not crazy; I'm just fat.

>

> Why the waste of good money seeing psychologists and

> psychiatrists before baryatric surgery? If a woman

> gets plastic surgery for a face lift or her boobs, she

> doesn't have to see a shrink beforehand.

[Guest guest]

As a person who does psych evaluations on a daily basis, I have long opposed

the need for the type of psych evals required pre op fro WLS. I do think

that there are a couple of things that the surgeon needs to know. One is

whether or not the patient is competent to make the decision to have the

surgery and maintain the life long vigilance to avoid malnutrition. The

second is whether or not the patient has a mental health disorder that may,

at times, so cloud their judgment that they believe they do not need to

comply with the post op requirements to maintain good health.

The reason that most surgeons require the psych eval is because it is part

of the NIH guidelines for surgery. And there are a few notable cases where

the cognitive function or the mental health of the post op patent was so

impaired that they put their life at risk with non compliance.

My personal bias is that pre ops find a therapist in their own community

that they feel comfortable working with. And that each pre op make an

agreement to see that person in the event of onset of depression or great

life stress post op.

The use of the MMPI and other psychological tools for the pre op WLS is pure

nonsense. Except that if the post op patient fails to do what is needed to

stay healthy the surgeon can't be sued for this. After all, they relied on

another professional for this information. The professional literature

indicates that there is no relationship between the results of these tests

and WLS outcomes. Reliance on these rather than a thorough personal

interview with the patient is indicative of how little most surgeons know

about the mental health profession. Some of the surgeons ask for a simple

letter from a professional saying that the patient understand the surgery,

has realistic expectations regarding outcomes, has no apparent personality

issues that would impair compliance, and is able to make this decision.

Seeing a " shrink " has nothing to do with being crazy. Being depressed,

having PTSD, being under great stress, and having emotional pain happen to

people during life. Seeing a professional for these can make some sense.

Suggesting that anyone who sees a mental health professional is " crazy " is a

barbaric notion. I'm sure that you wouldn't intentionally insult the many

people on this list who seek such professional help.

in Seattle

DS 1/5/01 295# BMI 47.6

4/5/01 240# BMI 38

Dr Welker - OHSU

----- Original Message -----

> I'm not crazy; I'm just fat.

>

> Why the waste of good money seeing psychologists and

> psychiatrists before baryatric surgery? If a woman

> gets plastic surgery for a face lift or her boobs, she

> doesn't have to see a shrink beforehand.

[Guest guest]

LCP:

It might be wise for you to consider speaking for yourself. Statements about WLS patients in general always hold true for some but not for others. And your comments really don't hold true for me.

You say:

> The inability to push away from the table and the> inactivity that accompany chronic obesity may be> nothing more than bad habits reinforced by> hypothalamic and other feedback mechanisms.

I would suggest that even though you may not have serious psychological problems some potential WLS patients do. I am a compulsive overeater and need psychological help with my problem. I have gotten it and the help has been as valuable as it was necessary. The purpose that most surgeons give for requiring the psychological consult is that they want to be sure the patients recognizes the seriousness of the surgery and is willing and able to commit to a lifetime of blood testing. In some cases the surgeons themselves feel capable of making those determinations and have time to do it during their consultation with the patient. In others they prefer to rely on a professional's opinion. I think that it makes good sense for a surgeon to understand their own limitations, both of skill and time.

You say:

> One of the allied problems with having the psych> people involved in this obesity business is that they> may steal some of the credit for the outcome from the> surgeon as well as the patient. This ain't right.

I have to say that I have never heard of this happening in my couple of years of being involved with weight loss surgery. If the psychologist claimed the credit for the success or was blamed for its failure I think that he or she would be laughed at rather than given the credit. And if he or she should be given the credit, so what?

My surgeon had a consultation with both me and my wife and felt no need for a specific psychological consult. Had he wanted one I'd have had no problem with doing it. Had I had an objection I would have had the option of going to another surgeon. The same holds true for other objections that people have with surgeons - such as charging a program fee above and beyond what they are paid by the insurance company. If you don't like it they can simply go to another surgeon.

Not feeling like a psychological consult is necessary does not make it so. And those of us who feel WLS is critically important to us are willing to submit to them with grace if not with relish.

Regards.

Joe Frost, old gentleman, not old fartSan , TX, 60 years oldDr. Welker 340 starting weight, currently 260http://www.duodenalswitch.com/Patients/Joe/joe.html

We're All Crazy, For Why Else Would We Have To Have To See A Shrink?

> I'm not crazy; I'm just fat.> > Why the waste of good money seeing psychologists and> psychiatrists before baryatric surgery? If a woman> gets plastic surgery for a face lift or her boobs, she> doesn't have to see a shrink beforehand. If a man gets> lung cancer from smoking too many cigarettes, does he> have to see a shrink before he has the surgery? Does> the chronic child bed-wetter see a shrink before he> has corrective surgery for, say, a weak urethra? Yet,> when an obese person has corrective gastric surgery,> many baryatric surgeons require that they see a> shrink. Of course, it's easy to explain it away as the> surgeon's covering their abnormally slender buttocks,> but is that really the root of this wasteful and> stupid practice?> > The inability to push away from the table and the> inactivity that accompany chronic obesity may be> nothing more than bad habits reinforced by> hypothalamic and other feedback mechanisms. Some have> said that the excess fats cells in us fatties make> untoward demands on our gullets. Mine cry out too> regularly; moreover, they are helped along by the> doxepin antidepressant I take that allows me to sleep.> That there is a genetic underpinning to the tendency> to get fat is probable, too. > > One of the allied problems with having the psych> people involved in this obesity business is that they> may steal some of the credit for the outcome from the> surgeon as well as the patient. This ain't right. On> the other hand, I see no reason not to speak with a> shrink to have them on our team to deal with any> depression or sleep disorder or whatever that we may> end up with post BPD/DS. > > In no instance, then, should the surgeon perceive that> their role is to evaluate fat people as insane for> overeating and, hence, not a good candidate for> obesity surgery. This is a foolish idea. The medical> insurance companies, too, have played a role in this> idiotic psychologization of what amounts to at bottom> a mere behavioral problem. Perhaps a wrong analogy is> operating here based upon anorexia nervosa patients> who often show marked psychpathologies. I think it is> about time that the baryatric surgeons stopped> treating us like a subclass of anorexics and realized> that eating too much ain't all that much different> than, say, promiscuous sex or drinking too much> alcohol or smoking to excess. > > These problems of the obese do not reflect insanity so> much as imprudence or lack of self-control. Problems> of self control are tough problems to deal with, as> every social engineer must recognize. None of these> excesses makes the satyromane or alcoholic or> 3-pack-a-day person mentally ill. We are a little> better than the above three types in so far as each of> us is a morbidly fat person desirous of being a> slender one, aye, crying out for skinniness. In short,> normal people can fall victim to bad eating habits and> get dangerously fat, without being mental cases. Sex> and alcohol and smoking are relatively easy to give> up, because they can be given up. Eating, on the other> hand, is hard to give up, unless that is, one has,> say, Crohn's Disease, and can only feed intravenously.> > The baryatric surgeons need to confront their> Medieval attitude like the gender reassignment> surgeons have lately had to confront the fact that> their reassignments have done much more harm than good> to the children they have operated on. It is> discriminatory to have us get shrink clearances> preoperatively. This is a baryatric surgeon practice> that needs to be halted at once. In reality, there is> no group of people in this country that face more> discrimination on a daily basis than us fatties except> for, maybe, the disabled. Please give your physician a> copy of this letter. You can even do it anonymously if> you want. The important thing is let him or her know> in some way that you don't go along with this nutty> idea. > > Best wishes, lcp > > PS. Thanks Beth for getting me to think along these> lines.> > > __________________________________________________>

[Guest guest]

LCP:

It might be wise for you to consider speaking for yourself. Statements about WLS patients in general always hold true for some but not for others. And your comments really don't hold true for me.

You say:

> The inability to push away from the table and the> inactivity that accompany chronic obesity may be> nothing more than bad habits reinforced by> hypothalamic and other feedback mechanisms.

I would suggest that even though you may not have serious psychological problems some potential WLS patients do. I am a compulsive overeater and need psychological help with my problem. I have gotten it and the help has been as valuable as it was necessary. The purpose that most surgeons give for requiring the psychological consult is that they want to be sure the patients recognizes the seriousness of the surgery and is willing and able to commit to a lifetime of blood testing. In some cases the surgeons themselves feel capable of making those determinations and have time to do it during their consultation with the patient. In others they prefer to rely on a professional's opinion. I think that it makes good sense for a surgeon to understand their own limitations, both of skill and time.

You say:

> One of the allied problems with having the psych> people involved in this obesity business is that they> may steal some of the credit for the outcome from the> surgeon as well as the patient. This ain't right.

I have to say that I have never heard of this happening in my couple of years of being involved with weight loss surgery. If the psychologist claimed the credit for the success or was blamed for its failure I think that he or she would be laughed at rather than given the credit. And if he or she should be given the credit, so what?

My surgeon had a consultation with both me and my wife and felt no need for a specific psychological consult. Had he wanted one I'd have had no problem with doing it. Had I had an objection I would have had the option of going to another surgeon. The same holds true for other objections that people have with surgeons - such as charging a program fee above and beyond what they are paid by the insurance company. If you don't like it they can simply go to another surgeon.

Not feeling like a psychological consult is necessary does not make it so. And those of us who feel WLS is critically important to us are willing to submit to them with grace if not with relish.

Regards.

Joe Frost, old gentleman, not old fartSan , TX, 60 years oldDr. Welker 340 starting weight, currently 260http://www.duodenalswitch.com/Patients/Joe/joe.html

We're All Crazy, For Why Else Would We Have To Have To See A Shrink?

> I'm not crazy; I'm just fat.> > Why the waste of good money seeing psychologists and> psychiatrists before baryatric surgery? If a woman> gets plastic surgery for a face lift or her boobs, she> doesn't have to see a shrink beforehand. If a man gets> lung cancer from smoking too many cigarettes, does he> have to see a shrink before he has the surgery? Does> the chronic child bed-wetter see a shrink before he> has corrective surgery for, say, a weak urethra? Yet,> when an obese person has corrective gastric surgery,> many baryatric surgeons require that they see a> shrink. Of course, it's easy to explain it away as the> surgeon's covering their abnormally slender buttocks,> but is that really the root of this wasteful and> stupid practice?> > The inability to push away from the table and the> inactivity that accompany chronic obesity may be> nothing more than bad habits reinforced by> hypothalamic and other feedback mechanisms. Some have> said that the excess fats cells in us fatties make> untoward demands on our gullets. Mine cry out too> regularly; moreover, they are helped along by the> doxepin antidepressant I take that allows me to sleep.> That there is a genetic underpinning to the tendency> to get fat is probable, too. > > One of the allied problems with having the psych> people involved in this obesity business is that they> may steal some of the credit for the outcome from the> surgeon as well as the patient. This ain't right. On> the other hand, I see no reason not to speak with a> shrink to have them on our team to deal with any> depression or sleep disorder or whatever that we may> end up with post BPD/DS. > > In no instance, then, should the surgeon perceive that> their role is to evaluate fat people as insane for> overeating and, hence, not a good candidate for> obesity surgery. This is a foolish idea. The medical> insurance companies, too, have played a role in this> idiotic psychologization of what amounts to at bottom> a mere behavioral problem. Perhaps a wrong analogy is> operating here based upon anorexia nervosa patients> who often show marked psychpathologies. I think it is> about time that the baryatric surgeons stopped> treating us like a subclass of anorexics and realized> that eating too much ain't all that much different> than, say, promiscuous sex or drinking too much> alcohol or smoking to excess. > > These problems of the obese do not reflect insanity so> much as imprudence or lack of self-control. Problems> of self control are tough problems to deal with, as> every social engineer must recognize. None of these> excesses makes the satyromane or alcoholic or> 3-pack-a-day person mentally ill. We are a little> better than the above three types in so far as each of> us is a morbidly fat person desirous of being a> slender one, aye, crying out for skinniness. In short,> normal people can fall victim to bad eating habits and> get dangerously fat, without being mental cases. Sex> and alcohol and smoking are relatively easy to give> up, because they can be given up. Eating, on the other> hand, is hard to give up, unless that is, one has,> say, Crohn's Disease, and can only feed intravenously.> > The baryatric surgeons need to confront their> Medieval attitude like the gender reassignment> surgeons have lately had to confront the fact that> their reassignments have done much more harm than good> to the children they have operated on. It is> discriminatory to have us get shrink clearances> preoperatively. This is a baryatric surgeon practice> that needs to be halted at once. In reality, there is> no group of people in this country that face more> discrimination on a daily basis than us fatties except> for, maybe, the disabled. Please give your physician a> copy of this letter. You can even do it anonymously if> you want. The important thing is let him or her know> in some way that you don't go along with this nutty> idea. > > Best wishes, lcp > > PS. Thanks Beth for getting me to think along these> lines.> > > __________________________________________________>

[Guest guest]

LCP:

It might be wise for you to consider speaking for yourself. Statements about WLS patients in general always hold true for some but not for others. And your comments really don't hold true for me.

You say:

> The inability to push away from the table and the> inactivity that accompany chronic obesity may be> nothing more than bad habits reinforced by> hypothalamic and other feedback mechanisms.

I would suggest that even though you may not have serious psychological problems some potential WLS patients do. I am a compulsive overeater and need psychological help with my problem. I have gotten it and the help has been as valuable as it was necessary. The purpose that most surgeons give for requiring the psychological consult is that they want to be sure the patients recognizes the seriousness of the surgery and is willing and able to commit to a lifetime of blood testing. In some cases the surgeons themselves feel capable of making those determinations and have time to do it during their consultation with the patient. In others they prefer to rely on a professional's opinion. I think that it makes good sense for a surgeon to understand their own limitations, both of skill and time.

You say:

> One of the allied problems with having the psych> people involved in this obesity business is that they> may steal some of the credit for the outcome from the> surgeon as well as the patient. This ain't right.

I have to say that I have never heard of this happening in my couple of years of being involved with weight loss surgery. If the psychologist claimed the credit for the success or was blamed for its failure I think that he or she would be laughed at rather than given the credit. And if he or she should be given the credit, so what?

My surgeon had a consultation with both me and my wife and felt no need for a specific psychological consult. Had he wanted one I'd have had no problem with doing it. Had I had an objection I would have had the option of going to another surgeon. The same holds true for other objections that people have with surgeons - such as charging a program fee above and beyond what they are paid by the insurance company. If you don't like it they can simply go to another surgeon.

Not feeling like a psychological consult is necessary does not make it so. And those of us who feel WLS is critically important to us are willing to submit to them with grace if not with relish.

Regards.

Joe Frost, old gentleman, not old fartSan , TX, 60 years oldDr. Welker 340 starting weight, currently 260http://www.duodenalswitch.com/Patients/Joe/joe.html

We're All Crazy, For Why Else Would We Have To Have To See A Shrink?

> I'm not crazy; I'm just fat.> > Why the waste of good money seeing psychologists and> psychiatrists before baryatric surgery? If a woman> gets plastic surgery for a face lift or her boobs, she> doesn't have to see a shrink beforehand. If a man gets> lung cancer from smoking too many cigarettes, does he> have to see a shrink before he has the surgery? Does> the chronic child bed-wetter see a shrink before he> has corrective surgery for, say, a weak urethra? Yet,> when an obese person has corrective gastric surgery,> many baryatric surgeons require that they see a> shrink. Of course, it's easy to explain it away as the> surgeon's covering their abnormally slender buttocks,> but is that really the root of this wasteful and> stupid practice?> > The inability to push away from the table and the> inactivity that accompany chronic obesity may be> nothing more than bad habits reinforced by> hypothalamic and other feedback mechanisms. Some have> said that the excess fats cells in us fatties make> untoward demands on our gullets. Mine cry out too> regularly; moreover, they are helped along by the> doxepin antidepressant I take that allows me to sleep.> That there is a genetic underpinning to the tendency> to get fat is probable, too. > > One of the allied problems with having the psych> people involved in this obesity business is that they> may steal some of the credit for the outcome from the> surgeon as well as the patient. This ain't right. On> the other hand, I see no reason not to speak with a> shrink to have them on our team to deal with any> depression or sleep disorder or whatever that we may> end up with post BPD/DS. > > In no instance, then, should the surgeon perceive that> their role is to evaluate fat people as insane for> overeating and, hence, not a good candidate for> obesity surgery. This is a foolish idea. The medical> insurance companies, too, have played a role in this> idiotic psychologization of what amounts to at bottom> a mere behavioral problem. Perhaps a wrong analogy is> operating here based upon anorexia nervosa patients> who often show marked psychpathologies. I think it is> about time that the baryatric surgeons stopped> treating us like a subclass of anorexics and realized> that eating too much ain't all that much different> than, say, promiscuous sex or drinking too much> alcohol or smoking to excess. > > These problems of the obese do not reflect insanity so> much as imprudence or lack of self-control. Problems> of self control are tough problems to deal with, as> every social engineer must recognize. None of these> excesses makes the satyromane or alcoholic or> 3-pack-a-day person mentally ill. We are a little> better than the above three types in so far as each of> us is a morbidly fat person desirous of being a> slender one, aye, crying out for skinniness. In short,> normal people can fall victim to bad eating habits and> get dangerously fat, without being mental cases. Sex> and alcohol and smoking are relatively easy to give> up, because they can be given up. Eating, on the other> hand, is hard to give up, unless that is, one has,> say, Crohn's Disease, and can only feed intravenously.> > The baryatric surgeons need to confront their> Medieval attitude like the gender reassignment> surgeons have lately had to confront the fact that> their reassignments have done much more harm than good> to the children they have operated on. It is> discriminatory to have us get shrink clearances> preoperatively. This is a baryatric surgeon practice> that needs to be halted at once. In reality, there is> no group of people in this country that face more> discrimination on a daily basis than us fatties except> for, maybe, the disabled. Please give your physician a> copy of this letter. You can even do it anonymously if> you want. The important thing is let him or her know> in some way that you don't go along with this nutty> idea. > > Best wishes, lcp > > PS. Thanks Beth for getting me to think along these> lines.> > > __________________________________________________>

[Guest guest]

Joe,

I couldn't say it better. One person can't speak for everyone. Sure, there are those who decide on WLS who are so stable that they don't need any help, but the doctors don't know you well enough to tell ofhand. So, they need to rely on a physchologist or therepists decision.

I suffer from what is now called " social panic disorder " and depression. These are compounded by my MO. I've been seeing a therepist for 5 years now. She suggested the WLS. She saw that my MO was just making me spend more and more time away from people. I would never get well without loosing the weight. She also saw that I would follow the doctors directions for aftercare.

Too many think that WLS is going to cure everything for them. It is just a tool and we need to know how to use it and be physchologially ready for the change in our lives.

Rita Black10/17/2000 First Consult. Dr.MacuraWeight 389 BMI 61Waiting on medical releases and insurance approval

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their share

of stupid psych evaluations, which include the MMPI,

or they are not. I think they are, and this is what B.

was complaining about.

What the baryatric community should be doing is making

sure that every chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't and

won't need a specialist shrink. Indeed, I am in favor

of most people having a psychologist or psychologist

interview them because it is a potential learning

opportunity. I am all for learning about ourselves,

but I resent going just because I'm fat and some

skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or treatment or to

all AIDS patients. This is in spite of the fact that

all three groups contain numbers of patients with

serious and severe mental disorders, many of which get

ignored and are untreated. Still, only the fatties

have to get psyched out. This is hardly guantum

mechanics.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.]

Fat people are being singled out for stupid psych

work-ups with psych tests in them because a few of our

number have preoperative psychological problems of a

severe kind related to their obesity and cannot be

counted on to observe the dietary necessities invited

by the baryatric surgery.

This still is not a good reason for all of us to have

these psych work-ups even if our beloved NIH says

otherwise. The NIH is a political insitution and

objectivity is often lacking in its pronouncements, as

its views on AIDS, for example, has shown. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is

not, even by penumbra, a single mention of health care

there or elsewhere in that charter. I doubt that our

forefathers who passed the Constitution would approve

how it is being ignored by the Beltway and a

dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I am then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased and prejudicial views need to

be told they are following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their share

of stupid psych evaluations, which include the MMPI,

or they are not. I think they are, and this is what B.

was complaining about.

What the baryatric community should be doing is making

sure that every chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't and

won't need a specialist shrink. Indeed, I am in favor

of most people having a psychologist or psychologist

interview them because it is a potential learning

opportunity. I am all for learning about ourselves,

but I resent going just because I'm fat and some

skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or treatment or to

all AIDS patients. This is in spite of the fact that

all three groups contain numbers of patients with

serious and severe mental disorders, many of which get

ignored and are untreated. Still, only the fatties

have to get psyched out. This is hardly guantum

mechanics.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.]

Fat people are being singled out for stupid psych

work-ups with psych tests in them because a few of our

number have preoperative psychological problems of a

severe kind related to their obesity and cannot be

counted on to observe the dietary necessities invited

by the baryatric surgery.

This still is not a good reason for all of us to have

these psych work-ups even if our beloved NIH says

otherwise. The NIH is a political insitution and

objectivity is often lacking in its pronouncements, as

its views on AIDS, for example, has shown. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is

not, even by penumbra, a single mention of health care

there or elsewhere in that charter. I doubt that our

forefathers who passed the Constitution would approve

how it is being ignored by the Beltway and a

dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I am then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased and prejudicial views need to

be told they are following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their share

of stupid psych evaluations, which include the MMPI,

or they are not. I think they are, and this is what B.

was complaining about.

What the baryatric community should be doing is making

sure that every chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't and

won't need a specialist shrink. Indeed, I am in favor

of most people having a psychologist or psychologist

interview them because it is a potential learning

opportunity. I am all for learning about ourselves,

but I resent going just because I'm fat and some

skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or treatment or to

all AIDS patients. This is in spite of the fact that

all three groups contain numbers of patients with

serious and severe mental disorders, many of which get

ignored and are untreated. Still, only the fatties

have to get psyched out. This is hardly guantum

mechanics.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.]

Fat people are being singled out for stupid psych

work-ups with psych tests in them because a few of our

number have preoperative psychological problems of a

severe kind related to their obesity and cannot be

counted on to observe the dietary necessities invited

by the baryatric surgery.

This still is not a good reason for all of us to have

these psych work-ups even if our beloved NIH says

otherwise. The NIH is a political insitution and

objectivity is often lacking in its pronouncements, as

its views on AIDS, for example, has shown. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is

not, even by penumbra, a single mention of health care

there or elsewhere in that charter. I doubt that our

forefathers who passed the Constitution would approve

how it is being ignored by the Beltway and a

dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I am then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased and prejudicial views need to

be told they are following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their share

of stupid psych evaluations, which include the MMPI,

or they are not. I think they are, and this is what B.

was complaining about.

What the baryatric community should be doing is making

sure that every chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't and

won't need a specialist shrink. Indeed, I am in favor

of most people having a psychologist or psychologist

interview them because it is a potential learning

opportunity. I am all for learning about ourselves,

but I resent going just because I'm fat and some

skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or treatment or to

all AIDS patients. This is in spite of the fact that

all three groups contain numbers of patients with

serious and severe mental disorders, many of which get

ignored and are untreated. Still, only the fatties

have to get psyched out. This is hardly guantum

mechanics.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.]

Fat people are being singled out for stupid psych

work-ups with psych tests in them because a few of our

number have preoperative psychological problems of a

severe kind related to their obesity and cannot be

counted on to observe the dietary necessities invited

by the baryatric surgery.

This still is not a good reason for all of us to have

these psych work-ups even if our beloved NIH says

otherwise. The NIH is a political insitution and

objectivity is often lacking in its pronouncements, as

its views on AIDS, for example, has shown. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is

not, even by penumbra, a single mention of health care

there or elsewhere in that charter. I doubt that our

forefathers who passed the Constitution would approve

how it is being ignored by the Beltway and a

dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I am then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased and prejudicial views need to

be told they are following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their share

of stupid psych evaluations, which include the MMPI,

or they are not. I think they are, and this is what B.

was complaining about.

What the baryatric community should be doing is making

sure that every chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't and

won't need a specialist shrink. Indeed, I am in favor

of most people having a psychologist or psychologist

interview them because it is a potential learning

opportunity. I am all for learning about ourselves,

but I resent going just because I'm fat and some

skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or treatment or to

all AIDS patients. This is in spite of the fact that

all three groups contain numbers of patients with

serious and severe mental disorders, many of which get

ignored and are untreated. Still, only the fatties

have to get psyched out. This is hardly guantum

mechanics.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.]

Fat people are being singled out for stupid psych

work-ups with psych tests in them because a few of our

number have preoperative psychological problems of a

severe kind related to their obesity and cannot be

counted on to observe the dietary necessities invited

by the baryatric surgery.

This still is not a good reason for all of us to have

these psych work-ups even if our beloved NIH says

otherwise. The NIH is a political insitution and

objectivity is often lacking in its pronouncements, as

its views on AIDS, for example, has shown. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is

not, even by penumbra, a single mention of health care

there or elsewhere in that charter. I doubt that our

forefathers who passed the Constitution would approve

how it is being ignored by the Beltway and a

dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I am then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased and prejudicial views need to

be told they are following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their share

of stupid psych evaluations, which include the MMPI,

or they are not. I think they are, and this is what B.

was complaining about.

What the baryatric community should be doing is making

sure that every chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't and

won't need a specialist shrink. Indeed, I am in favor

of most people having a psychologist or psychologist

interview them because it is a potential learning

opportunity. I am all for learning about ourselves,

but I resent going just because I'm fat and some

skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or treatment or to

all AIDS patients. This is in spite of the fact that

all three groups contain numbers of patients with

serious and severe mental disorders, many of which get

ignored and are untreated. Still, only the fatties

have to get psyched out. This is hardly guantum

mechanics.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.]

Fat people are being singled out for stupid psych

work-ups with psych tests in them because a few of our

number have preoperative psychological problems of a

severe kind related to their obesity and cannot be

counted on to observe the dietary necessities invited

by the baryatric surgery.

This still is not a good reason for all of us to have

these psych work-ups even if our beloved NIH says

otherwise. The NIH is a political insitution and

objectivity is often lacking in its pronouncements, as

its views on AIDS, for example, has shown. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is

not, even by penumbra, a single mention of health care

there or elsewhere in that charter. I doubt that our

forefathers who passed the Constitution would approve

how it is being ignored by the Beltway and a

dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I am then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased and prejudicial views need to

be told they are following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their undue

share of stupid psych evaluations, which include the

MMPI, or they are not. I think they are, and this is

what B. was complaining about.

What the baryatric community should be doing is making

sure that the chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't

and won't need a specialist shrink. Indeed, I am in

favor of most people having a psychologist or

psychologist interview them because it is a potential

learning opportunity. I am all for learning about

ourselves, but I resent going just because I'm fat and

some skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or to all AIDS

patients. This is in spite of the fact that all three

groups contain numbers of patients with serious and

severe mental disorders, many of which get ignored and

are untreated. Still, only the fatties have to get

psyched out.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.] Fat people are being singled out for

stupid psych work-ups with psych tests in them because

a few of our number have preoperative psychological

problems of a severe kind related to their obesity and

cannot be counted on to observe the medical

necessities invited by the baryatric surgery.

This is not a good reason for all of us to have these

psych work-ups even if our beloved NIH says otherwise.

The NIH is a political insitution and objectivity is

often lacking in its pronouncements. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is not

a single mention of health care by penumbra or

otherwise. I doubt that our forefathers who passed the

Constitution would approve how it is being ignored by

the Beltway and a dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I amm then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased views need to be told they are

following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their undue

share of stupid psych evaluations, which include the

MMPI, or they are not. I think they are, and this is

what B. was complaining about.

What the baryatric community should be doing is making

sure that the chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't

and won't need a specialist shrink. Indeed, I am in

favor of most people having a psychologist or

psychologist interview them because it is a potential

learning opportunity. I am all for learning about

ourselves, but I resent going just because I'm fat and

some skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or to all AIDS

patients. This is in spite of the fact that all three

groups contain numbers of patients with serious and

severe mental disorders, many of which get ignored and

are untreated. Still, only the fatties have to get

psyched out.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.] Fat people are being singled out for

stupid psych work-ups with psych tests in them because

a few of our number have preoperative psychological

problems of a severe kind related to their obesity and

cannot be counted on to observe the medical

necessities invited by the baryatric surgery.

This is not a good reason for all of us to have these

psych work-ups even if our beloved NIH says otherwise.

The NIH is a political insitution and objectivity is

often lacking in its pronouncements. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is not

a single mention of health care by penumbra or

otherwise. I doubt that our forefathers who passed the

Constitution would approve how it is being ignored by

the Beltway and a dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I amm then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased views need to be told they are

following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their undue

share of stupid psych evaluations, which include the

MMPI, or they are not. I think they are, and this is

what B. was complaining about.

What the baryatric community should be doing is making

sure that the chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't

and won't need a specialist shrink. Indeed, I am in

favor of most people having a psychologist or

psychologist interview them because it is a potential

learning opportunity. I am all for learning about

ourselves, but I resent going just because I'm fat and

some skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or to all AIDS

patients. This is in spite of the fact that all three

groups contain numbers of patients with serious and

severe mental disorders, many of which get ignored and

are untreated. Still, only the fatties have to get

psyched out.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.] Fat people are being singled out for

stupid psych work-ups with psych tests in them because

a few of our number have preoperative psychological

problems of a severe kind related to their obesity and

cannot be counted on to observe the medical

necessities invited by the baryatric surgery.

This is not a good reason for all of us to have these

psych work-ups even if our beloved NIH says otherwise.

The NIH is a political insitution and objectivity is

often lacking in its pronouncements. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is not

a single mention of health care by penumbra or

otherwise. I doubt that our forefathers who passed the

Constitution would approve how it is being ignored by

the Beltway and a dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I amm then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased views need to be told they are

following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their undue

share of stupid psych evaluations, which include the

MMPI, or they are not. I think they are, and this is

what B. was complaining about.

What the baryatric community should be doing is making

sure that the chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't

and won't need a specialist shrink. Indeed, I am in

favor of most people having a psychologist or

psychologist interview them because it is a potential

learning opportunity. I am all for learning about

ourselves, but I resent going just because I'm fat and

some skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or to all AIDS

patients. This is in spite of the fact that all three

groups contain numbers of patients with serious and

severe mental disorders, many of which get ignored and

are untreated. Still, only the fatties have to get

psyched out.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.] Fat people are being singled out for

stupid psych work-ups with psych tests in them because

a few of our number have preoperative psychological

problems of a severe kind related to their obesity and

cannot be counted on to observe the medical

necessities invited by the baryatric surgery.

This is not a good reason for all of us to have these

psych work-ups even if our beloved NIH says otherwise.

The NIH is a political insitution and objectivity is

often lacking in its pronouncements. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is not

a single mention of health care by penumbra or

otherwise. I doubt that our forefathers who passed the

Constitution would approve how it is being ignored by

the Beltway and a dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I amm then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased views need to be told they are

following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their undue

share of stupid psych evaluations, which include the

MMPI, or they are not. I think they are, and this is

what B. was complaining about.

What the baryatric community should be doing is making

sure that the chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't

and won't need a specialist shrink. Indeed, I am in

favor of most people having a psychologist or

psychologist interview them because it is a potential

learning opportunity. I am all for learning about

ourselves, but I resent going just because I'm fat and

some skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or to all AIDS

patients. This is in spite of the fact that all three

groups contain numbers of patients with serious and

severe mental disorders, many of which get ignored and

are untreated. Still, only the fatties have to get

psyched out.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.] Fat people are being singled out for

stupid psych work-ups with psych tests in them because

a few of our number have preoperative psychological

problems of a severe kind related to their obesity and

cannot be counted on to observe the medical

necessities invited by the baryatric surgery.

This is not a good reason for all of us to have these

psych work-ups even if our beloved NIH says otherwise.

The NIH is a political insitution and objectivity is

often lacking in its pronouncements. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is not

a single mention of health care by penumbra or

otherwise. I doubt that our forefathers who passed the

Constitution would approve how it is being ignored by

the Beltway and a dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I amm then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased views need to be told they are

following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

Sorry, gang, if anyone thought that I was speaking for

all fatties. What I was really interested in was

speaking to all BPD/DS fatties and doing a little

consciousness-raising. I am not a puff ball. I believe

in freedom of preach! I want fat people to get a fair

shake from the medical community. I want us to be

treated like individuals, not as members of the fat

group. This is what discrimination and prejudice are

all about. Certainly the responses my words provoked

were individualistic, even if some over-reacted or

simply did not bother to assimilate what was before

them.

's response was most thoughtful. Still, you canna

have your cake and eat it too, dearie. Either fat

people are being singled out for more than their undue

share of stupid psych evaluations, which include the

MMPI, or they are not. I think they are, and this is

what B. was complaining about.

What the baryatric community should be doing is making

sure that the chronically and morbidly obese patient

has a good relationship with his personal physician or

other health care worker. Why? In order to deal with

any post-op psychological needs of the patient

relating to preop psychiatric problems or post-op

weight loss-related depression, etc. Indeed, most

personal physicians can handle the psychotropic

medications of most patients, and most of us don't

and won't need a specialist shrink. Indeed, I am in

favor of most people having a psychologist or

psychologist interview them because it is a potential

learning opportunity. I am all for learning about

ourselves, but I resent going just because I'm fat and

some skinny jerk at the NIH thinks that fat people are

nuts. The MMPI is definitely where I think it's not

at.

My point is that the psych evaluations in the

baryatric community are not being done to all lung

cancer treatment patients prior to chemotherapy or

radiation or surgery or to all the cirrhosis patients

prior to having a liver transplant or to all AIDS

patients. This is in spite of the fact that all three

groups contain numbers of patients with serious and

severe mental disorders, many of which get ignored and

are untreated. Still, only the fatties have to get

psyched out.

I have a neighbor, for example, that has been treated

for lung cancer, which is in permanent remission. He

continues to smoke and suffer from a plethora of

smoking related psychiatric problems, most of which

are undiagnosed. [There is, I believe, an end-stage

smoking syndrome that afflicts many long-time smokers

characterized by depression, procrastination, and

withdrawal.] Fat people are being singled out for

stupid psych work-ups with psych tests in them because

a few of our number have preoperative psychological

problems of a severe kind related to their obesity and

cannot be counted on to observe the medical

necessities invited by the baryatric surgery.

This is not a good reason for all of us to have these

psych work-ups even if our beloved NIH says otherwise.

The NIH is a political insitution and objectivity is

often lacking in its pronouncements. The Federal

Government has no constitutional role to play in

health care, frankly, unless you wish to believe that

health care falls under the " commerce clause " in the

Constitution and your ises are like the previous

president's did.

That the NIH is at the center of this discriminatory

practice should not surprise anyone who is a student

of totalitarianism and discrimination, which I am.

Read Article I, Section 8, clauses 1-18. The powers

of the Congress are detailed therein, and there is not

a single mention of health care by penumbra or

otherwise. I doubt that our forefathers who passed the

Constitution would approve how it is being ignored by

the Beltway and a dumbed-down people.

What's wrong with this business is that, thanks to a

one-size-fits-all mindset from a top-down and illegal

government medical quango, we are not being treated as

individuals but as members of a group. I amm then, not

in favor of making this preop a no-brainer for the

overpaid surgeons. Let fall on the shoulders of these

overpaid and overworshipped baryatric technicians the

responsibility of making sure that those select

patients with psych histories and probable need of a

proper psych interview work-up be singled out. That

many baryatric surgeons, and surgeons generally, are

loath to follow up on their patients is not news. Many

have a lousy after-the-operation attitude.

In short, the NIH guidelines relating to weight-loss

surgery are wrong, discriminatory, and a waste of

patient time and money. Baryatric surgeons falling

victim to these biased views need to be told they are

following discriminatory practices.

You sound like a bunch of whimpering wimps so far, so

I am not sanguine that any consciousness raising is

possible in this group. Is there anyone out there with

the guts to point out this instance of

guideline-related discrimination originating with the

Federal Government to their surgeon or shrink?

I guess I must be cracked to have hoped otherwise.

Maybe I'll have to see a shrink about it....

Most sincerely and sweetly yours,

lcp

--- Montgomery marym@...> wrote:

> As a person who does psych evaluations on a daily

> basis, I have long opposed

> the need for the type of psych evals required pre op

> fro WLS. I do think

> that there are a couple of things that the surgeon

> needs to know. One is

> whether or not the patient is competent to make the

> decision to have the

> surgery and maintain the life long vigilance to

> avoid malnutrition. The

> second is whether or not the patient has a mental

> health disorder that may,

> at times, so cloud their judgment that they believe

> they do not need to

> comply with the post op requirements to maintain

> good health.

>

> The reason that most surgeons require the psych eval

> is because it is part

> of the NIH guidelines for surgery. And there are a

> few notable cases where

> the cognitive function or the mental health of the

> post op patent was so

> impaired that they put their life at risk with non

> compliance.

>

> My personal bias is that pre ops find a therapist in

> their own community

> that they feel comfortable working with. And that

> each pre op make an

> agreement to see that person in the event of onset

> of depression or great

> life stress post op.

>

> The use of the MMPI and other psychological tools

> for the pre op WLS is pure

> nonsense. Except that if the post op patient fails

> to do what is needed to

> stay healthy the surgeon can't be sued for this.

> After all, they relied on

> another professional for this information. The

> professional literature

> indicates that there is no relationship between the

> results of these tests

> and WLS outcomes. Reliance on these rather than a

> thorough personal

> interview with the patient is indicative of how

> little most surgeons know

> about the mental health profession. Some of the

> surgeons ask for a simple

> letter from a professional saying that the patient

> understand the surgery,

> has realistic expectations regarding outcomes, has

> no apparent personality

> issues that would impair compliance, and is able to

> make this decision.

>

> Seeing a " shrink " has nothing to do with being

> crazy. Being depressed,

> having PTSD, being under great stress, and having

> emotional pain happen to

> people during life. Seeing a professional for these

> can make some sense.

> Suggesting that anyone who sees a mental health

> professional is " crazy " is a

> barbaric notion. I'm sure that you wouldn't

> intentionally insult the many

> people on this list who seek such professional help.

>

> in Seattle

> DS 1/5/01 295# BMI 47.6

> 4/5/01 240# BMI 38

> Dr Welker - OHSU

>

>

>

> ----- Original Message -----

>

>

> > I'm not crazy; I'm just fat.

> >

> > Why the waste of good money seeing psychologists

> and

> > psychiatrists before baryatric surgery? If a woman

> > gets plastic surgery for a face lift or her boobs,

> she

> > doesn't have to see a shrink beforehand.

>

>

>

----------------------------------------------------------------------

>

[Guest guest]

I found out today a letter denying me was sent out Friday. I'll probably get it

today. I guess I need to appeal now but I've got an exclusion for no obesity

treatment. Does anyone have any copies of letters written for appeal that argue

the morbidly obese are not excluded? I don't know what to do next but I need

to hurry as we're going on a new contract in May and I want this posted before

then. What really bugs me is they never saw the dr letter i sent in today so I

dont think I had a chance. I dont think I do anyway...but I have to at least

try.

Thanks

AJ

BMI 58

1st denial 4/06/01

NW Washington Medical (Regence BC/BS)

>

[Guest guest]

I found out today a letter denying me was sent out Friday. I'll probably get it

today. I guess I need to appeal now but I've got an exclusion for no obesity

treatment. Does anyone have any copies of letters written for appeal that argue

the morbidly obese are not excluded? I don't know what to do next but I need

to hurry as we're going on a new contract in May and I want this posted before

then. What really bugs me is they never saw the dr letter i sent in today so I

dont think I had a chance. I dont think I do anyway...but I have to at least

try.

Thanks

AJ

BMI 58

1st denial 4/06/01

NW Washington Medical (Regence BC/BS)

>

[Guest guest]

I found out today a letter denying me was sent out Friday. I'll probably get it

today. I guess I need to appeal now but I've got an exclusion for no obesity

treatment. Does anyone have any copies of letters written for appeal that argue

the morbidly obese are not excluded? I don't know what to do next but I need

to hurry as we're going on a new contract in May and I want this posted before

then. What really bugs me is they never saw the dr letter i sent in today so I

dont think I had a chance. I dont think I do anyway...but I have to at least

try.

Thanks

AJ

BMI 58

1st denial 4/06/01

NW Washington Medical (Regence BC/BS)

>

[Guest guest]

ROFLMFAO

Well we have been known to blood let on occasion, if you are

voluntering for such sanquine sports, please do not hesitate to lie

your fat body down upon the altar of sacrifice.

Everyone is entitled to their opinions, what is that old saying,

opinions are like assholes, everyone has one, some groups have more

than others, then again extra drainage sources are needed by some.

I applaud your position, it is not without great merit, and perhaps

if you'd like to attend the next conference of the NIH when they are

voting or discussing their position on " bariatric " surgery you might

sway the hierarchy, or start a petition, many here would no doubt

support it, including myself.

has always been right on about the aftercare portion of psych

support. It does not take a half moron to realize whether someone is

able to make decisions concerning their own life course. It is about

being sued after the fact however, and their is some rumblings in the

plastic community that psych evals should be an intrinsic part of

their practice, some already incorporate them anyway.

Us " wimps " welcome you, however remember some of us " wimps " are not

for the faint of heart, esp those of us that that enjoy blood

sports

Wishing you mental health, lol

deb desade

[Guest guest]

--- Pflanz Leonard thepflanz@...> wrote:

> That many baryatric surgeons, and surgeons generally, are

> loath to follow up on their patients is not news. Many

> have a lousy after-the-operation attitude.

On the contrary, my surgeon has amazing follow up and is unlike any

other doctor I have ever been treated by. I think you would find this

to be true for most of the DS surgeons who tend to end up on pedestals

because they really are a different breed of doctor.

> You sound like a bunch of whimpering wimps so far, so

> I am not sanguine that any consciousness raising is

> possible in this group.

You would probably find it easier to converse with a group of people if

you were less offensive. I happen to agree that the psych evaluation is

probably overkill but I have a really hard time reading what you have

to say because you say it in such a condescending manner.

Me thinks you must be a troll. You certainly write and act like one.

=====

H

Dr. Keshishian 11-21-00

__________________________________________________

[Guest guest]

--- Pflanz Leonard thepflanz@...> wrote:

> That many baryatric surgeons, and surgeons generally, are

> loath to follow up on their patients is not news. Many

> have a lousy after-the-operation attitude.

On the contrary, my surgeon has amazing follow up and is unlike any

other doctor I have ever been treated by. I think you would find this

to be true for most of the DS surgeons who tend to end up on pedestals

because they really are a different breed of doctor.

> You sound like a bunch of whimpering wimps so far, so

> I am not sanguine that any consciousness raising is

> possible in this group.

You would probably find it easier to converse with a group of people if

you were less offensive. I happen to agree that the psych evaluation is

probably overkill but I have a really hard time reading what you have

to say because you say it in such a condescending manner.

Me thinks you must be a troll. You certainly write and act like one.

=====

H

Dr. Keshishian 11-21-00

__________________________________________________