What Happens at a Pulmonary Clearance for Bariatric Surgery

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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. You’ll start the exam like any other appointment and then discuss issues like smoking, breathing, snoring and chest tightness. The doctor may order further testing, such as a sleep study or a pulmonary function test, as well as follow-up appointments. 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. They state that the National Surgical Quality Improvement program indicated that six percent of patients who had 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 among others. Since many bariatric patients have obstructive sleep apnea with their obesity, it’s a good idea to have your lungs checked prior to 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. Your height, weight, blood pressure and pulse will be checked. Then you’ll have a discussion with your pulmonologist. You’ll talk about your pulmonary history, like asthma and snoring.

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 clearance. We first discussed my breathing. While I had never been diagnosed with asthma in the past, I did reveal to her that I do 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 did help ease 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. 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 sleep study revealed that I did stop breathing in my sleep, and then I had to take a sleep study at the hospital to get fitted for my titration. You can learn more about what to expect at this sleep study by reading this post.

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 for me to assess my lung capacity.

Further Testing

As the doctor does his or her examination, they are going to identify the risk factors you have that may lead to pulmonary complications during or after surgery. They may order further testing to identify undiagnosed 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 really hard into a mouthpiece. The respiratory therapist instructs on when to breathe normally and when to breathe out as hard as you can. 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 states that the arterial gas analysis is rarely needed for pulmonary clearance for bariatric surgery. However, if they do order it, it’s a test that measures the acidity and levels of oxygen and carbon dioxide in the blood from an artery. It’s basically measuring 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 special 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, 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. This is another test that is rarely needed for surgery.

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 really easy 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.

Follow-Up Care

If the doctor ordered further testing for you at your pulmonary clearance for bariatric surgery, they may want to see you back in a few months to see how the therapies are working. For example, is the inhaler prescribed to you helping to lessen your symptoms? Are you using your CPAP machine regularly? Are you less sleepy during the daytime because of the use of your machine? 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 was definitely helping. As I lose 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’s time and I had lost over 200 pounds, 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 NSV!

Your Pulmonary Clearance for Bariatric Surgery

While another doctor’s appointment seems tiresome, it’s important to get your pulmonary clearance for bariatric surgery if your doctor or insurance company requires it. It’s a normal 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 it’s completed, you can celebrate another milestone towards your surgery!

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In Summary

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