published Tuesday, June 25th, 2013

Discussing the mental stress of surgery can be helpful

By the time Cheryl Rossing was asked to have a psychological/sociological screening before bariatric surgery in 2011, it didn't bother her a whit.

"Once you get to this point," the Hixson resident recalls of that request, "you've gone through all the fad diets that have worked or haven't worked. You have to be in your right mind to want to go that far."

Rossing is one of an increasing number of patients scheduled for certain surgical procedures who are screened from a psychological standpoint. Studies have shown presurgical psychological screenings are helpful in predicting surgical outcomes. One 2001 study in an issue of The Spine Journal said such screenings achieved 82 percent success in predicting outcomes.

"We're trying to prevent psychosocial disasters in operations that could be injurious," says Dr. Jack Rutledge, a general surgeon in Chattanooga who has specialized in bariatric surgery for 11 years. "It's an opportunity to set ourselves up for success once we jump into the water. It's a safer journey for our patient. That's our goal."

Rutledge says when he asks patients to have the screening, he is quick to disarm them before they think "whether I'm heavy doesn't mean I'm crazy.

"We're looking for medical problems," he says, "but we're also trying to reinforce psychosocial lifestyles that are critical."

Like Rutledge, Dr. Andrew Block, of the Texas Back Institute and one of the authors of The Spine Journal study, says the referral of a patient to another professional for a psychological screening should not be viewed as a sign the patient has mental issues.

"It should be viewed as a sign that there is an appreciation for how stressful back pain can be, as well as another possible means to help the patient control pain," he says in information on the Texas Back Institute website (www.texasback.com). "Psychological treatment for back pain support may also help patients to have a realistic view of their spinal conditions and the planned treatments."

Rossing, 54, says before her bariatric sleeve surgery she was asked to see a nutritionist, go through a class and see a licensed clinical social worker for a psychosocial evaluation.

The steps, she says, "were to make sure your health is going to get better" and that you would be "in the right frame of mind" for the surgery and what would happen afterward.

The questions, says Rossing, who lost 135 pounds and now weighs around 140, involved whether or not she had a support system, how she thought the surgery would affect her life, if she thought it would be a success, if she thought the procedure would make things better immediately.

"They want you to be ready for all the changes that come along with [the procedure]," she says.

The number of patients who are not fit to have surgery because of psychosocial issues is not a large one, Rutledge says.

"Those exist," he says, "but almost anybody can get there. That's the value of the screening -- finding those people [who] won't be able to deal with the psychology, who perceive bypass and sleeve [operations] as just plumbing."

Block said factors found to negatively affect surgical outcome include depression, anxiety, anger, body image and stress.

He says screenings help identify the risk factors, allow surgical teams to individualize treatment to the patient's specific situation, lower the risk factors, improve compliance and anticipate problems that might occur following surgery.

Indeed, Block says, everyone benefits.

If very high levels of psychosocial risk are identified before surgery, he says, the recommendation is to avoid or delay surgery, preventing the patient from undergoing a surgical procedure likely to fail.

If the presurgical screening suggests the go-ahead, Block says, the surgeon can be assured the patient is likely to experience the desired results from surgery, thus improving the surgeon's effectiveness and minimizing the likelihood the patient will fail or develop new problems as a result of the surgery.

Further, he says, third-party payers, including Medicare, will see a reduced cost due to increased surgical effectiveness, minimizing the likelihood for additional surgery and avoiding negative post-operation consequences.

"I require that almost all patients pre-op get a psychological evaluation," Rutledge says.

If his team's nutritional screening and psychosocial counseling red-flag someone, he says, the patient is referred out. However, some insurance companies, he says, require outside surgical counseling, though they may not "know what to look for."

He also requests patients visit him six times in the first year after surgery.

Rossing, who is "very proud of what I've done," says the classes and screenings helped her learn what might happen, how things might occur and what she would need to do to take care of herself.

"Everything [they] said made perfect sense," she says. "It prepares you for what you may not have thought of before surgery."

Contact staff writer Clint Cooper at ccooper@timesfreepress.com or 423-757-6497. Subscribe to his posts online at Facebook.com/ClintCooperCTFP.

about Clint Cooper...

Clint Cooper is the faith editor and a staff writer for the Times Free Press Life section. He also has been an assistant sports editor and Metro staff writer for the newspaper. Prior to the merger between the Chattanooga Free Press and Chattanooga Times in 1999, he was sports news editor for the Chattanooga Free Press, where he was in charge of the day-to-day content of the section and the section’s design. Before becoming sports ...

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