Financial Counseling and Charity Care

financial counselorsFinancial counselors are here to talk with you about your hospital bills and to ease any concern you may have about them. The financial counselors’ offices are on the ground floor in the Registration area in the lobby, close to the hospital entrance. Financial counselors are available weekdays from 8 a.m. until 3 p.m. No appointment is necessary. To call the financial counselor from outside the hospital, dial 304-526-6099 or 304-526-6344. Patients may simply dial 6099 or 6344 from their rooms.

To be eligible for uncompensated services, your family income must be at or below the following levels:

Family Size UnitFederal Poverty Guidelines80% Discount given on 120% FPG60% Discount given on 140% FPG40% Discount given on 350% FPG
For each additional person, add $4,160
1 $11,770 $14,124 $16,478 $41,195
2 $15,930 $19,116 $22,302 $55,755
3 $20,090 $24,108 $28,126 $70,315
4 $24,250 $29,100 $33,950 $84,875
5 $28,410 $34,092 $39,774 $99,435
6 $32,570 $39,084 $45,598 $113,995
7 $36,730 $44,076 $51,442 $128,555
8 $40,890 $49,068 $57,246 $143,115

Revised: March 1, 2015

If you think you may be eligible for uncompensated services, you may complete the application return it to a Financial Counselor in the Registration Area Monday through Friday from 8 a.m. to 4 p.m.

  • So that a determination of your eligibility for uncompensated care may be made quickly, please be prepared to furnish documents verifying your income.
  • You may be asked to make an application for assistance (Medicare, Medicaid, Insurance etc.) for payment of your hospital charges.

Remember, your health and well-being are our primary concern. You will be registered and treated regardless of your ability to pay.

 

 

                                                             Table of Contents

 

Before Surgery……………………………………………………………………….…………………………….           2

            Pre-Operative Education Class…………………………………………………………………..          2

            Pre-Admission Testing………………………………………………………….……………………          2

            Pre-Operative Appointment………………………………………………………………………          3

            Preparation for Your Surgery…………………………………………………...……………….          3

            Medication and Preparation Prior to Surgery…………………………………………… 4

Day of Surgery…………………………………………………………………………..………………………….           5

            The Operating Room…………………………………………………………………………………           5

            The Operation…………………………………………………………………….…………………….           5           

            Surgery Time…………………………………………………………………………………………….           6

            Your Gallbladder………………………………………………………………….……………………          6

            Your Liver………………………………………………………………………………………………….           7

            Recovery Room…………………………………………………………………..…………………….           7

            Your Private Room…………………………………………………………….…………………    7

After Surgery…………………………………………………………………………...……….………………….           8

            Post-Operative Day 1…………………………………………………………..……………………           8

            Post-Operative Day 2…………………………………………………………….………………….           9

            Post-Operative Day 3…………………………………………………………..……………………           9

            Steps to Help Prevent Deep Vein Thrombosis/Pulmonary Embolism……….10

            Care of Your G/J-Tube……………………………………………………………….……………..11

            Caring for Your Jackson Pratt (JP) Drain………………………………………..………….12

Discharge Instructions……………………………………………………..…………………………..………13

            Activity, Medications, Vitamins and Minerals, When to Call the Office,

            Support Group, Diet, Exercise

Medications After Surgery…………………………………………………………….…………………….19       

Frequently Asked Questions………………………………………..………………..…………………….21      

Conclusion…………………………………………………………………………….………………………….…23

 

 

Before Surgery

 

The most important part of this journey is learning all you can about obesity, nutrition, exercise and the different surgical procedures available to treat obesity. This information helps you make a careful and informed decision about having weight-loss surgery.

 

You have already taken the first step by attending an educational seminar where you learned the risks and benefits of weight-loss surgery. You may also find it very helpful to talk to people who have already been through this experience. Please call our office at 304.399.4121 to make arrangements to attend support group meetings and hear from patients who have already had a procedure.

 

Surgery is now scheduled, and you are on your way to a healthier life. The information in this manual will help you understand what to expect.  Please review it carefully to be sure you are fully prepared for your upcoming procedure.

 

 

Pre-Admission Testing

Prior to surgery, you will need to register at Cabell Huntington Hospital and visit the Pre-Admission Testing office. Please be sure to take a complete list of your current medications.  A nurse will review your medical history and medications and perform a physical examination. You will then be sent for blood work and any other testing that may be needed.

 

Pre-Operative Education Class

You will be required to attend a 90-minute pre-operative education class prior to your surgery date. During this class, the nurse will discuss the risks and benefits of surgery and what you can expect during your hospitalization. You will see the tubes or drains that may be placed in your abdomen, depending on which procedure you have chosen. You will also be given an incentive spirometer (a device for breathing exercises) to practice at home and bring back to the hospital when you have surgery.

 

The nurse will also review your bowel prep before surgery, which medications to take and to hold the morning of surgery and pain control after surgery. The nurse will answer any remaining questions and give you a true/false exam specific to the type of weight-loss surgery you’ve chosen. Consent forms will be completed and signed.

 

Pre-Operative Appointment with Your Surgeon

About one week before your procedure, you will have an appointment with your surgeon to review your medical history and the risks and benefits of the procedure. You will have a chance to ask questions and discuss the consent forms.

 

Medication and Preparation Prior to Surgery

Because the medications you usually take may affect how your body responds during or after surgery, it is important to follow the individual medication recommendations you were given in Pre-Admission Testing, as well as the general guidelines below:

 

7 days before surgery 

a) Stop taking aspirin or aspirin-containing medications one full week prior to your

 scheduled procedure.  (Examples: Alka-Seltzer, Goody’s Headache Powders, Excedrin,

 Celebrex, Aleve,  naproxen, ibuprofen).

 

b) Stop taking any birth control or hormone replacement therapy. This medication

should not be restarted until 30 days after your surgery, as it may increase your risks of

developing a ____________  ___________.  Be sure to use an alternative form of birth

control during these 30 days. We do not recommend you become pregnant for the

first 24 months after weight-loss surgery.

 

c) Stop taking phentermine.

 

72 hours/3 days before surgery 

Unless you were told otherwise by your surgeon, stop taking any type of blood thinner

such as heparin, Lovenox (enoxaparin), Coumadin (warfarin), Pradaxa (dabigatran), Xarelto (rivaroxaban), Plavix (clopidogrel) or Eliquis (apixaban).

 

48 hours before surgery

a) Stop taking Glucophage (metformin).

 

b) No bowel prep medication is used.

 

c) You will begin a  _____________   ______________ diet.  

You will need to drink as much caffeine-free and non-carbonated liquid as you can tolerate, using the following guidelines:

o   Water or flavored water (G2, Crystal Light, popsicles)

o   Clear broth (beef, chicken bouillon)

o   Caffeine-free tea

o   Caffeine-free coffee (no cream)

o   Clear juices (orange juice, apple, grape, cranberry)

o   JELL-O (reds and purples are okay)

 

If your surgery is Monday, start this diet on ______________________ morning.

If your surgery is Tuesday, start this diet on ______________________ morning.

If your surgery is Wednesday, start this diet on ___________________ morning.

 

The night before surgery

a)     Stop taking any diabetic medications.

 

b)     The night before your surgery after midnight you will be NPO, which means  ____________________________________________.

 

 

The morning of surgery: Do NOT take any diuretics or “water pills," such as Lasix (furosemide), Demadex (torsemide), Bumex (bumetanide), HCTZ  (hydrochlorothiazide) or medications containing HCTZ or Aldactone (spironolactone).

 

Unless already mentioned, it is okay to take medications that you typically take during the morning , such as anti-depressants, reflux medication, blood pressure medication, etc.  If your blood pressure medication contains a diuretic, then do not take it the morning of surgery. If you are uncertain about any of your medications falling into one of these categories, you may call your pharmacist.

 

The Day of Surgery

Please report to second floor of Cabell Huntington Hospital at the time you were given and check in at the surgery desk. Your procedure will not begin until pre-operative preparations, which usually take about two hours, are complete. You will be called back to a room to change into a hospital gown and have another physical examination performed by the nurse. Safety is the first priority, so please be patient if you are asked the same questions repeatedly. Different staff members are responsible for your care, and it is vital that they ensure they have the correct information.

 

The nurse will begin hydrating you with IV fluids, and once you are ready for surgery, two family members may wait with you until you are taken to the pre-operative prep area. During this time, a member of the anesthesiology staff will visit to discuss pain control and sedation options. You will be given routine IV antibiotics to help prevent infection and, as it gets closer to your procedure starting, you will be given light sedation. You will then be moved to the operating room for your surgery.

 

Sometimes, there may be a delay in your surgery because the surgeon is taking longer than expected with the patient ahead of you. Please be patient, knowing that the surgeon will give you the same kind of care and attention during your procedure.

 

The Operating Room

Once you arrive in operating room, you will be asked to slide onto the table and breathe oxygen through a mask. This will increase your blood oxygen levels prior to anesthesia being administered. When you are ready, medication will be injected into your IV and you will drift into a relaxing sleep.

 

After you are asleep, you will be inhaling anesthetic gases to keep you completely unaware. A tube will be inserted down your throat, directly into your airway. After that, medicines will be administered to relax your muscles and a ventilator will breathe for you.  The anesthesiologist will monitor your blood pressure, pulse, respiratory rate, muscle tension and blood oxygen levels continuously throughout the operation.

 

Your Surgery

After you are sedated, the nurses will position your body on the operating room table. Your skin will be cleansed with an antiseptic to decrease the chance of infection. Sterile drapes will be placed over your body, leaving only a small window over the abdomen through which the operation is performed.

 

Laparoscopic  Procedure. Weight-loss surgery performed by laparoscopy uses several small incisions instead of one large incision. Between four and six small incisions will be made in your abdomen to allow several ports and a tiny camera to assist the surgeon can be safely inserted. These incisions will be closed with an absorbable suture hidden just below the skin level, and the edges are closed with Dermabond, a sterile skin adhesive.  In some cases, staples may be required.

 

Open Procedure. If you are having an open procedure, your incision will be made directly downward from the lower end of your breastbone, usually about five inches. Once the abdomen is open, your surgeon will check your organs for any obvious abnormalities. If anything unexpected is found, the surgeon will talk to your family and make a decision about how to proceed.  Your incision is closed with very strong sutures, which minimizes the chance for hernias to form.

 

Your Surgery Time

Each patient is different, and surgery does not always begin and end as scheduled. On average, gastric bypass surgery lasts two hours

gastric sleeve resection lasts one and a half hours

adjustable gastric band lasts one hour

 

There is no reason for your family to be alarmed your procedure extends beyond the estimated time. There are many different reasons why surgery can take longer than expected.

 

Your Gallbladder

A gallbladder is not routinely removed during weight-loss surgery; however, patients having  a gastric bypass or gastric sleeve resection may have the gallbladder removed if it is abnormal or causing symptoms. Removing it during  your weight-loss procedure keeps you from having to return for another major surgery to remove it if your gallbladder causes problems later on.

 

Your Liver

Often, the liver is enlarged with deposits of fat within its cells. Sometimes the liver is so large that laparoscopic surgery cannot be performed, and an open procedure may be necessary.  If your liver looks abnormal, a biopsy may be performed to investigate further.

 

The Recovery Room

 

After your surgery, you will be taken to the recovery room, where nurses will closely monitor your vital signs until you are awake. Your breathing tube will be removed before you are awakened. You will be asked questions to assess your sedation and pain level. While you are in recovery, the surgeon will speak to your family members.

 

Your Private Room

Once you are stable, you will be moved to a private room.  After you are settled in, your family will be allowed to visit. The nurse will perform your physical assessment and frequently monitor your vital signs, urinary output and tube drainage. If you have a drainage tube, it should be secured to your gown with a safety pin to prevent it from accidentally being pulled out.

 

Your nurse will have you perform your incentive spirometer exercises and assist you in turning, coughing and deep breathing.  You should continue to use the incentive spirometer ________ times per _________ while you are awake.   If you have obstructive sleep apnea, you will need to have your CPAP equipment/machine with you at the hospital.

 

Because everyone experiences pain differently, your nurse will ask you to rate your pain on a scale of 0-10, with 10 being the worst. You may have a pain pump clipped to your gown. Use this as often as needed to control your pain.  If you feel your pain is not well controlled, do not hesitate to tell your nurse.

 

 

Using Your PCA (Patient Controlled Analgesia) Pump

 

·       Your PCA pump delivers pain medication through your IV.

·       The pump is programmed to administer only the amount of medication your doctor ordered, and only at the intervals your doctor specified.

·       Push the PCA button when you begin to feel pain; your nurse can show you how.

·       Call your nurse if your pain is not relieved.

·       For your safety, ONLY YOU should push the button on your pump. Family members, friends or visitors should not push the button.

·       All pain medication can cause side effects.  Some of the most common side effects include:                      

o   Nausea

o   Vomiting

o   Itching without a rash (ask your nurse about taking an antihistamine)

o   Constipation (ask your nurse about taking a stool softener)

 

 

 
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


If you require a higher level of observation after surgery, you may be moved to the Surgical Intensive Care Unit (SICU), where you will be closely monitored until stabilized.  When the doctor determines that you are ready, you will be moved to a room on 2 North. There, you will continue to receive IV fluids and be monitored closely, and you can take walks to hasten your recovery.

 

If you had a Roux-en-Y Gastric Bypass or Gastric Sleeve Resection, you are not allowed to eat or drink the day of surgery, including ice chips. You will receive hydration through IV fluids and given sponges to wet your mouth, which may be dry from the anesthesia.  If you had an Adjustable Gastric Band procedure, your surgeon may permit you to have ice chips and sips of water. If at any time you become nauseated, the ice and water will be stopped and you will receive hydration only through your IV and sponges.

 

Remember ― the sooner you start moving, the faster your recovery time. You will be expected to get up and walk __________  hours after surgery, and every ____________ hours thereafter.  If you want to get up sooner, ask the nurse to help you or find a staff member to assist. Family members are welcome to walk with you. Once you feel strong enough to do walk on your own, you need not ask. Moving may be hard at first, but it will get easier each time. 

 

After Surgery

 

Post-Operative Day 1

On Day 1, your goal is to take several walks and do your deep breathing exercises.

A swallowing study, called an upper gastrointestinal study or UGI, will be performed in Radiology. Although the radiologist may indicate your test results look normal, your surgeon must review the study, too. If it is found to be normal, an order will be given allowing you to start Stage 1 diet of sugar-free, clear liquids.

 

Drinking liquids after surgery will be very different, and it is important to pay attention to how your body reacts. Your stomach will not be able to hold as much, and just one swallow may be enough to make you feel full. Be sure to wait about five minutes before taking another sip to allow the liquid to empty out of your stomach. It is okay to drink water steadily, but if you feel full or nauseated, you are drinking too much and/or too fastRemember, when you feel full, STOP!  It’s okay to not finish all that is on your tray.

 

During Day 1, your PCA pump will be discontinued, and patients with a Foley catheter will have it removed. Your nurse will give you a scheduled dose of pain medication every eight hours as needed. You will also have an order for Lortab elixir, which you must ask for as needed. blood will be drawn in the early morning hours, If ordered by your surgeon,. Vital signs will continue to be monitored every 4 hours. You will be given two injections: a blood thinner and a vitamin B-12 injection.  If you feel nauseated at any time, tell your nurse. She will be able to give you Zofran, an anti-nausea medication.  Drainage from any tube will be watched closely and after checking with your nurse, you may be permitted to shower.

 

Patients who have undergone laparoscopic adjustable gastric banding may be discharged on this day between the hours of 3 p.m. and 6 p.m. if they are tolerating food and pain is under control. If not, an additional night may be needed.

  • Last updated: 03/04/2015
  • Share |

Watch Video

View more videos