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One of the many stops on your bariatric surgery journey is a pulmonary clearance. The point of this clearance is to assess your lung function and identify any issues that may lead to complications with your bariatric surgery. You’ll start the exam like any other appointment and discuss topics like smoking, breathing, snoring and chest tightness. The doctor may order further testing, such as a sleep study or a pulmonary function test, and follow-up appointments. These tests are to test you for underlying lung conditions that could affect the outcome of your surgery. The pulmonary clearance for bariatric surgery checks your risk for pulmonary complications during and after your surgery.
Why It’s Necessary
It’s necessary to get a pulmonary clearance for bariatric surgery to assess your lung function and determine any underlying pulmonary issues that could affect you during or after surgery. UpToDate has a great article that provides in-depth information about pulmonary clearances. The report states that the National Surgical Quality Improvement Program indicated that six percent of patients with major abdominal surgery had post-op pulmonary complications. Risk factors for complications include age, chronic obstructive pulmonary disease (COPD), asthma, smoking, obesity and obstructive sleep apnea. Since many bariatric patients have obstructive sleep apnea with their obesity, it’s good to have your lungs checked before surgery.
At Your Pulmonary Clearance for Bariatric Surgery
When you arrive for your pulmonary clearance for bariatric surgery, you’ll start as most doctor appointments do. You’ll sign in with the receptionist, and when they call you back, they’ll take your vitals. The nurse will check your height, weight, blood pressure, and oxygen saturation. Then you’ll talk about your pulmonary history, like asthma and snoring with the doctor.
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They may assess you for obstructive sleep apnea by measuring your neck circumference and taking a questionnaire. The questionnaire I took was called the Epworth Sleepiness Scale, and it gives the doctor an idea of how well you are sleeping. You rate how likely you are to doze in certain situations, like watching TV or riding in a car. If you are excessively tired during the day, you may not be getting adequate sleep. If you are sleeping for seven to eight hours and are still tired, it may be worth getting checked for sleep apnea. I scored an 11 on the ESS, which is considered mild excessive daytime sleepiness.
My Experience
When I went for my pulmonary clearance, I met with a very sweet nurse practitioner. I explained to her that I wanted to get bariatric surgery and needed a pulmonary approval. We first discussed my breathing. While my doctor never diagnosed me with asthma in the past, I revealed to her that I cough and get chest tightness when I exercise, get exposed to cold air or smell a strong perfume. It only lasts for about 30 minutes after the trigger, and then seems to clear. She believed that I had exercise-induced asthma and prescribed an inhaler for me to use. It eased the discomfort I had when I got an attack, so I was thankful for a solution to that situation.
As I wrote earlier, she also assessed me for obstructive sleep apnea. My FitBit Charge 2 revealed I didn’t get enough sleep at night, and I confessed my sleep wasn’t very sound. I told her that people tell me I snore. Between that information, my neck circumference and my score of 11 on the ESS, she recommended I get a home sleep study. The overnight sleep study revealed that I stopped breathing in my sleep, and then I had to take a sleep study at the hospital to get fitted for my titration. I then regularly used my CPAP to ensure my proper sleep for my surgery.
Other than those issues, I told her that I have had surgeries in the past and had no complications with them, including pulmonary complications. Still, between my possible exercise-induced asthma, obstructive sleep apnea and obesity, she ordered a pulmonary function test to assess my lung capacity.
How to Prepare for a Pulmonary Clearance
As you are progressing through your weight loss surgery requirements, a pulmonary clearance is likely a stop in your journey. To prepare for this appointment, you’ll do some of the same things you did for your other meetings. For example, you should bring a list of past diet histories, any previous or current medical issues, a list of your medications, including dosage and frequency, family medical history, and any previous surgeries. If you have pulmonary problems, like shortness of breath, difficulty breathing, or chest pain, make sure you tell the pulmonologist this information so he or she can appropriately evaluate you.
I often talk about how bariatric surgery is life-changing. As an obese person, you may avoid doctor’s offices for fear of being judged or feeling ridiculed. As a result, you may uncover several medical issues as you journey to your bariatric surgery. I know because I was in your same shoes. I was scared of going to the doctor, scared of what my issues could mean for my future and survival. In my journey to surgery, the doctor’s diagnosed me with polycystic ovarian syndrome, obstructive sleep apnea, stomach ulcers and exercise-induced asthma. Had I not pursued bariatric surgery, these issues would have only worsened and threatened my livelihood. Since seeking treatment for my obesity and my obesity-related condition, I quite literally saved my life.
Start Making Changes Today
The reason I write this information isn’t to scare you, but rather so that you can learn from my experience. Finding out about these medical issues gave me more motivation to explore the benefits of bariatric surgery. It gave me the motivation to continue losing weight and get to the operating table. I started by changing some essential habits in my life, which ultimately led to my 235- pound weight loss. I go into detail on these habits, and give you tips for transforming your life with progress trackers in my Bariatric Beginner’s Workbook. If you are pursuing bariatric surgery, I highly suggest you purchase this workbook to get started. It will help you establish the best habits to succeed with bariatric surgery. But hurry, because it’s only available for a limited time!
Perioperative Pulmonary Evaluation
As the doctor does his or her examination, they will identify the risk factors you have that may lead to pulmonary complications during or after bariatric surgery. They may order further testing to identify possible lung disorders. They’ll be looking for decreased breath sounds, wheezing, low-pitched rattling in the lungs or prolonged exhales. Some of the tests they may order are a pulmonary function test (PFT), an arterial gas analysis, a chest X-ray or exercise testing.
Pulmonary Function Test
The pulmonary function test uses spirometry to measure the forced exhale volume in one second. It’s a test unlike any I’ve had before. You sit in a booth that reminded me of a telephone booth and breathe hard into a mouthpiece. The respiratory therapist instructs you on when to breathe normally and when to breathe out as possible. You have to do it several times to get accurate readings. Later, they have you inhale some albuterol and repeat the tests to see if it makes a difference. It took about 30 to 45 minutes for the whole test. It was painless and just a different experience than I’m used to having.
Arterial Gas Analysis
The UpToDate article referenced above states that the arterial gas analysis is rarely needed for pulmonary clearance for bariatric surgery. However, if the doctor does order it, it’s a test that measures the acidity and levels of oxygen and carbon dioxide in the blood from an artery. It measures how well your lungs can move oxygen to the blood and remove carbon dioxide from the blood. For this test, blood is taken from an artery rather than a vein and tested in a lab.
Chest X-Ray
A chest x-ray is another possible test the pulmonologist will order to look at the structure of your lungs and make sure everything looks okay for surgery. You’ll have to stand against a wall with a protective apron around your waist to prevent excessive radiation on other parts of your body. You may stand in front of a barrier instead that only exposes your chest. The x-ray technologist will ask you to hold your breath as they take the pictures of your lungs for the doctor to view.
Exercise Testing
There’s a particular stress test they can do called a metabolic stress test. It’s similar to a stress test you may get for your cardiac clearance. You’ll walk on a treadmill or ride a stationary bike while breathing into a unique mouthpiece, and the technologists will measure your heart and lung function while under physical stress. They want to see how your lungs will react in a stressful environment.
Sleep Study
Your doctor may also recommend a sleep study. An at-home sleep study involves a machine that is like a large watch that you place on your wrist. There is a cord with an oxygen sensor on it for you to put on your finger. Another cord tapes to the center of your chest to measure your breathing and snoring. It’s effortless to hook up, and you press a button to let it know you’re going to sleep. It measures your oxygen levels and snoring. If this returns positive, you may have to go for an overnight sleep study, where they’ll fit you for a CPAP titration and see how well you sleep with it.
RELATED CONTENT: Want to learn the 10 changes you need to make in your life to be successful with bariatric surgery? Get our free download here!
Follow-Up Care
If the doctor ordered further testing for you at your pulmonary clearance for bariatric surgery, they might want to see you back in a few months to see how the therapies are working. For example, is the prescribed inhaler helping to ease your symptoms? Are you using your CPAP machine regularly? Are you less sleepy during the daytime because of the use of your device? These are all questions your doctor may need before she gives you the go-ahead for bariatric surgery.
My doctor wanted to see me in three months, and I told her that the inhaler helped. As I lost weight, I didn’t need it as often and barely use it to this day. I also told her that I used my CPAP machine most nights, and have better quality sleep when I do use it. She told me to continue the therapy, especially in the months before surgery and to check back in a year. After a year, I lost over 200 pounds, so she ordered a follow-up sleep study to check on my sleep apnea. I no longer had it! It’s still one of my favorite non-scale victories.
Your Pulmonary Clearance for Bariatric Surgery
While another doctor’s appointment seems tiresome, it’s essential to get your pulmonary clearance for bariatric surgery if your doctor or insurance company requires it. It’s a regular office visit where you’ll discuss issues with your lungs. The doctor may order further testing to make sure there are no underlying lung issues. The pulmonary clearance for bariatric surgery checks your risk for pulmonary complications during and after surgery. Once you complete this clearance, you can celebrate another milestone towards your surgery!
If this article gave you some great ideas to incorporate into your life, just imagine what other amazing strategies I have for you! Share this post on social media by clicking one of the sharing buttons, and don’t forget to join my email list! You’ll be the first to get updates, access to my new products and lots of tips, inspiration and motivation to help in your bariatric surgery journey. Just for joining, I’ll send you a free Bariatric Beginner’s Guide to get you started, as well as some other pretty awesome goodies to keep you motivated. Join today!
In Summary
They’ll check your vitals, like height, weight, blood pressure, oxygen saturation, heart rate and temperature. The doctor will discuss pulmonary issues you have had before, such as asthma or smoking. The doctor will assess your risk factors for certain lung diseases like obstructive sleep apnea. They’ll listen to your heart and lungs, and may order further testing to determine your lung function.
There are many tests done before bariatric surgery, however, each surgeon, hospital, and insurance company have different requirements. Some of the pulmonary tests you may have done are a pulmonary function tests, an overnight sleep study, an arterial gas analysis, a chest x-ray, or a metabolic stress test.
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