I didn't sleep last night because we all know I am a procrastinator. I was awake packing and had to make a run tot he office to put the finishing touches on a presentation for a perspective employer :-) I got to the airport at 4:15 in the am. JFK, terminal 5, Jetblue! The ONLY way to fly! On the plane by 5:45am and passed out before the plane even took off. I woke up about 20 minutes before we landed. Thank goodness for those two hours of sleep. Landed in Sunny beautiful Orlando, FL at 8:45am, picked up my rental car and headed for the hotel.
I had an hour before my first class so I grabbed some ASMBS sponsored lunch! Dear ASMBS, thank you so very much for ensuring that I eat at least one meal a day because the cost of your conference has me wiped!
Onto my first class... Masters in Behavioral Health Part One... The Pre-op Eval. I totally thought this was going to be like a psych or social work class I took in school. Boy was I wrong. 3 Abstracts... All talking about using various psychological scales during the pre-op eval.
Abstract 1.
Construct Validity and Clinical Utility of the MMPI-2-RF Among Bariatric Surgery Candidates.
By: Anthony Tarescavage
While I was able to follow this abstract, Anthony spoke very fast and zipped through his slides. Once he started talking about Standard Deviation I have to admit my mind kinda zoned out. I tried to be there I really did but I am not a fan of research. I don't mind gathering data but once it comes time to analyze it... That's just not my strength. The basic jist of the talk (at least what I got from it, is that the MMPI-2-RF is a restructured clinical scale which encompasses 51 different scales in 338 questions. Each of these 338 items are taking from the original MMPI 2 which is initially over 500 questions. I think he was trying to say that the data showed a positive correlation between certain items and either a positive or negative outcome post-operatively. To be honest, I personally didn't feel that the data presented was conclusive enough to show positive correlation between the MMPI 2 RF and post-op outcomes. But then again perhaps I was just too zoned out to get it.
Abstract 2.
Differences in Psychological Profiles of Sugar Cravers.
By: Kerry B. Ferguson
The basic premise here was that many patients pre-op, self reported during their psych eval that they were Sugar Cravers. Such scales were used as the Carb Addiction Scale and the BDI (depression scale) and the results showed that 75% of sleeve and bypass patients self reported that after surgery their cravings for sugar disappeared. There was also a positive correlation between Depression and Sugar Cravings. I personally don't think enough research was done here. The presenter neglected to provide a clear and universal definition of what a Sugar Craver is, so therefore there is really no baseline from which to measure. I think there is much more to be discovered here.
Abstract 3.
SCL-90R Profiles and Weight Loss Outcomes Among Bariatric Surgery Candidates.
By: Kathleen Ashton
Yet another talk on the benefits of using certain psychological scales to predict outcome of a bariatric surgery candidate. The findings here stated that Patients with a positive clinical profile lost 9% less than their negative clinical profiled peers. This was prob one of the most well thought out and interesting of the abstracts with regard to the psychological scales being used as a predictor for post-operative weight loss outcome.
These three abstracts led to a very interesting discussion about the place of mental health professionals and the pre-op psych eval in pre-op patient care. There seems to be an unspoken yet widely accepted belief that Mental Health professionals are supposed to be able to predict, based on the evaluation, and tell the surgeon, if a particular patient is "good candidate" for bariatric surgery. The unspoken agreement is that a good candidate is one who will comply with the rules, and lose and maintain a certain percentage of their excess weight. Not for nothing, I can't tell you that! No one can. We can give our best guess but really it's a 50/50 shot. Either the patient will or wont. I think the mental health professionals in this field along with the ASMBS need to change the way the pre-op psych eval is viewed. Instead of it being a predictive factor, perhaps we can view it as more of an intake in which we use psychological scales to best gauge a post-op treatment plan for each individual patient. I think we need to require as part of a patients complete treatment of obesity, that patients have 6 sessions of therapy after bariatric surgery and more if needed. As one surgeon got up and said during this discussion, his patients who have severe and persistent mental illnesses like schizophrenia, who engage in regular weekly therapy and medication management are some of his most successful and compliant patients. GO FIGURE! What do you think? Do you think we should try to predict outcomes or help patients attain the outcomes they desire? What changes would you make?
The discussion turned to billing codes for all of these psych evals and I left. I cannot and do not accept insurance and listening to the fees some of these folks charge makes me feel like I am selling myself short.
So I went to hang out at the OAC booth with my good friend Jeff Haaga! Have you all joined the Obesity Action Coalition yet? They are having a half price membership sale here at ASMBS and raffling off 3 Apple TVs! I personally hold 2 memberships to the OAC. a regular membership and a professional one. I spoke to Jeff about more ways I could get involved. After his release from booth duty and we sold a few memberships, I joined him for dinner to discuss some new possibilities for me. I have been invited to join a committee within the OAC. I have a few choices to consider. Once I know more I will fill you all in :-)After dinner, I headed over to Beth and Andrea's hotel to say a quick hello and girlie banter a bit. On the way back to my hotel, I finally found me a Starbucks!!! Woohoo! Got my iced latte and headed back tot he hotel. Long day... but well worth it! I am looking forward to sharing tomorrows sessions with you and all of the extra curricular invite only parties and cocktail hours! Tomorrow night is the OAC's member only party. I look forward to meeting the board members and those that make the OAC tick.
'til tomorrow friends,
xoxo
Sleeve Pixie
