Bariatric Surgery and Fertility: What You Need to Know

Bariatric surgery is a life-changing procedure that can help individuals struggling with obesity achieve long-term weight loss and improve their overall health. In addition to its physical benefits, bariatric surgery can also have a positive impact on fertility. However, it's important to remember that you should not try to get pregnant until cleared by your surgeon. Here's what you need to know about bariatric surgery and fertility.

1. Improving fertility: Bariatric surgery can improve fertility by reducing insulin resistance and inflammation, which can improve ovulation and menstrual regularity in women, and improve sperm quality and testosterone levels in men.

2. Waiting to get pregnant: It's important to wait to get pregnant until cleared by your surgeon. Your surgeon will provide guidance on when it is safe to try to conceive, which is typically 12-18 months after surgery.

3. Nutritional considerations: It's important to work with a registered dietitian to ensure that you are getting the necessary nutrients for a healthy pregnancy after bariatric surgery. This may include nutritional supplements such as folic acid and iron.

4. Emotional considerations: Pregnancy can be a stressful time for anyone, and it's important to seek support from a therapist if needed. A therapist can help you manage the emotional and psychological impacts of pregnancy after bariatric surgery, including any concerns about body image or self-esteem.

In summary, bariatric surgery can improve fertility, but it's important to wait to get pregnant until cleared by your surgeon. Working with a registered dietitian and seeking support from a therapist can also be helpful in managing the emotional and nutritional aspects of pregnancy after bariatric surgery. If you're considering bariatric surgery as a treatment option and have questions about its potential impact on fertility or pregnancy, talk to your healthcare provider, including a mental health professional.

How Bariatric Surgery Can Improve Medical Conditions

Bariatric surgery is a life-changing procedure that can help individuals struggling with obesity achieve long-term weight loss and improve their overall health. In addition to weight loss, bariatric surgery can also have a positive impact on a variety of medical conditions. Here are some examples of how bariatric surgery can improve medical conditions.

1. Type 2 diabetes: Bariatric surgery can lead to significant improvements in blood sugar control and insulin resistance, making it an effective treatment option for individuals with type 2 diabetes.

2. High blood pressure: Bariatric surgery can help lower blood pressure and reduce the risk of heart disease and stroke.

3. Sleep apnea: Bariatric surgery can improve sleep apnea by reducing the amount of excess tissue in the throat and reducing the risk of airway obstruction during sleep.

4. Joint pain: Excess weight can put a significant amount of stress on the joints, leading to pain and inflammation. Bariatric surgery can help reduce joint pain and improve mobility.

5. Acid reflux: Bariatric surgery can help reduce the symptoms of acid reflux by reducing the pressure on the stomach and improving the function of the esophageal sphincter.

6. Fatty liver disease: Bariatric surgery can help improve fatty liver disease by reducing the amount of fat in the liver and improving liver function.

In summary, bariatric surgery can have a significant impact on a variety of medical conditions. By achieving long-term weight loss, bariatric surgery can help improve blood sugar control, lower blood pressure, improve sleep apnea, reduce joint pain, reduce symptoms of acid reflux, and improve fatty liver disease. If you're considering bariatric surgery as a treatment option for obesity or related medical conditions, talk to your surgeon and a mental health professional about the potential benefits and challenges of the procedure.

Preparing for Bariatric Surgery: Managing Low Energy Levels

Bariatric surgery can be a life-changing procedure for individuals struggling with obesity, but it's important to remember that the recovery process can be challenging. One common issue that many individuals face after bariatric surgery is low energy levels. This can be caused by a variety of factors, including changes in diet, hormone levels, and physical activity levels. Here are some tips for managing low energy levels and preparing for bariatric surgery.

1. Talk to your surgeon: Your surgeon can provide you with information about what to expect in terms of energy levels after bariatric surgery, as well as strategies for managing them. This may include nutritional supplements or recommendations for physical activity.

2. Focus on nutrition: Proper nutrition is essential for managing low energy levels after bariatric surgery. Work with a registered dietitian to develop a meal plan that is high in protein, fiber, and other essential nutrients.

3. Stay hydrated: Dehydration can lead to low energy levels, so it's important to drink plenty of fluids throughout the day. Aim for at least 64 ounces of water per day, and avoid sugary or caffeinated beverages.

4. Get enough rest: Proper rest is essential for managing low energy levels after bariatric surgery. Make sure to get at least 7-8 hours of sleep each night, and listen to your body when it tells you that you need rest.

5. Gradually increase physical activity: While physical activity is important for overall health and energy levels, it's important to start slowly and gradually increase activity levels after bariatric surgery. Talk to your surgeon about recommended physical activity levels, and listen to your body when it tells you that you need rest.

In summary, managing low energy levels is an important part of preparing for bariatric surgery. By talking to your surgeon, focusing on nutrition, staying hydrated, getting enough rest, and gradually increasing physical activity levels, you can manage low energy levels and achieve long-term success after bariatric surgery. If you're struggling with low energy levels or other challenges related to bariatric surgery, consider seeking the support of a therapist who can help you navigate these challenges and achieve your goals.

Preparing for Bariatric Surgery: Understanding Emotional Impacts of Hair Loss

Bariatric surgery can be a life-changing procedure for individuals struggling with obesity, but it's important to understand that there may be emotional impacts to consider. One of these is hair loss, which can occur as a result of rapid weight loss after bariatric surgery. While hair loss is a common side effect of the procedure, it can still be a difficult experience to navigate emotionally. Here are some tips for preparing for bariatric surgery with a focus on understanding and managing emotional impacts of hair loss.

1. Understand the causes of hair loss: Hair loss after bariatric surgery is often caused by a combination of factors, including changes in hormone levels, nutrient deficiencies, and stress on the body. Understanding the causes of hair loss can help you prepare for and manage the emotional impacts.

2. Talk to your surgeon: Your surgeon can provide you with information about the likelihood and severity of hair loss after bariatric surgery, as well as strategies for managing it. This may include nutritional supplements, hair care tips, or medication to promote hair growth.

3. Seek support: Hair loss can be a difficult experience to navigate emotionally, and it's important to seek support from friends, family, and a therapist if needed. A therapist can help you address any negative self-talk or body image issues that may arise as a result of hair loss.

4. Practice self-care: Taking care of yourself physically and emotionally can help you manage the emotional impacts of hair loss. This may include exercise, meditation, or engaging in hobbies that bring you joy.

5. Embrace your new look: While hair loss can be a difficult experience, it's important to remember that it's a temporary side effect of bariatric surgery. Embracing your new look and focusing on the positive changes in your health and well-being can help you navigate the emotional impacts of hair loss.

In summary, understanding and managing the emotional impacts of hair loss is an important part of preparing for bariatric surgery. By understanding the causes of hair loss, talking to your surgeon, seeking support, practicing self-care, and embracing your new look, you can navigate the emotional challenges of hair loss and achieve long-term success after bariatric surgery. If you're struggling with the emotional impacts of hair loss or other side effects of bariatric surgery, consider seeking the support of a therapist who can help you manage these challenges and achieve your goals.

How to Research Bariatric Surgery: Choosing the Best Option for You

Bariatric surgery is a significant decision that requires careful consideration and research. With so many options available, it can be overwhelming to determine which type of bariatric surgery is best for you. Here are some tips for researching bariatric surgery and choosing the best option for you.

1. Understand the Different Types of Bariatric Surgery: There are several types of bariatric surgery, including gastric bypass, gastric sleeve, adjustable gastric band, and biliopancreatic diversion with duodenal switch. Research the different types of surgery to understand the benefits, risks, and potential outcomes of each option.

2. Evaluate Your Health and Weight Loss Goals: Evaluate your current health status, weight loss goals, and any existing medical conditions to determine which type of surgery may be the best fit for you.

3. Seek Professional Guidance: Consult with a qualified healthcare provider, such as a bariatric surgeon, to discuss your options and receive guidance on the best type of surgery for your specific needs.

4. Research the Surgical Center and Surgeon: Research the surgical center and surgeon to ensure that they are qualified, experienced, and reputable. Look for online reviews and testimonials, and ask for references if necessary.

5. Consider Insurance Coverage and Cost: Research insurance coverage and cost for the different types of bariatric surgery to determine the most affordable and feasible option for you.

6. Attend a Seminar or Support Group: Attend a bariatric surgery seminar or support group to learn more about the different types of surgery, the surgery process, and post-operative care.

In summary, researching bariatric surgery is an important step in determining the best type of surgery for your needs. Understanding the different types of surgery, evaluating your health and weight loss goals, seeking professional guidance, researching the surgical center and surgeon, considering insurance coverage and cost, and attending a seminar or support group are all effective ways to research bariatric surgery. Remember, the decision to undergo bariatric surgery should be carefully considered and made with the guidance of a qualified healthcare provider.

Preparing for Bariatric Surgery: Understanding Weight Loss and Happiness

Bariatric surgery can be a powerful tool for weight loss, but it's important to remember that weight loss doesn't necessarily equal happiness. While losing weight can lead to improvements in physical health, self-esteem, and overall well-being, it's important to approach bariatric surgery with realistic expectations and a focus on overall health and happiness. Here are some tips for preparing for bariatric surgery with a focus on happiness and well-being.

1. Set realistic expectations: It's important to approach bariatric surgery with realistic expectations about weight loss and how it will impact your life. While weight loss can lead to improvements in health and self-esteem, it's not a cure-all for all of life's problems.

2. Focus on overall health: Rather than focusing solely on weight loss, aim to improve your overall health and well-being through bariatric surgery. This may include developing healthy eating habits, engaging in regular physical activity, and practicing self-care.

3. Address emotional issues: Bariatric surgery can bring up emotional issues related to body image, self-esteem, and relationships. Working with a therapist to address these issues can help you navigate the emotional challenges of weight loss and find happiness and fulfillment in your life.

4. Build a support network: Support from friends, family, and a therapist can be invaluable in preparing for bariatric surgery and achieving long-term happiness and well-being. Consider joining a support group or seeking individual therapy to help you build a strong support network.

5. Practice gratitude: Focusing on gratitude and cultivating a positive mindset can help you find happiness and fulfillment in your life, regardless of your weight. Take time each day to reflect on the things you're grateful for and focus on the positive aspects of your life.

6. In summary, preparing for bariatric surgery with a focus on happiness and well-being can help you achieve long-term success and fulfillment. By setting realistic expectations, focusing on overall health, addressing emotional issues, building a support network, and practicing gratitude, you can find happiness and fulfillment in your life, regardless of your weight. If you're considering bariatric surgery, consider seeking the support of a therapist who can help you navigate the emotional challenges of weight loss and find happiness and well-being in your life.

Preparing for Bariatric Surgery: Managing Emotional Eating

Bariatric surgery can be a life-changing procedure for individuals struggling with obesity, but it's important to remember that the success of the surgery depends on more than just the physical aspects. Emotional eating, or eating in response to emotions rather than hunger, can be a significant barrier to achieving long-term weight loss goals after bariatric surgery. Here are some tips for managing emotional eating and preparing for bariatric surgery.

1. Identify emotional triggers: The first step in managing emotional eating is to identify the emotions that trigger it. Common triggers include stress, anxiety, boredom, and loneliness. Keeping a food diary can be helpful in identifying patterns and triggers.

2. Develop healthy coping mechanisms: Once you've identified your emotional triggers, it's important to develop healthy coping mechanisms for managing them. This may include exercise, meditation, deep breathing, or talking to a therapist.

3. Build a support network: Support from friends, family, and a therapist can be invaluable in managing emotional eating and preparing for bariatric surgery. Consider joining a support group or seeking individual therapy to help you build a strong support network.

4. Practice mindful eating: Mindful eating involves paying attention to the sensory experience of eating and being fully present in the moment. This can help you become more aware of your hunger and fullness cues, and reduce the likelihood of emotional eating.

5. Make healthy food choices: Choosing healthy, nutrient-dense foods can help you manage emotional eating and prepare for bariatric surgery. Aim for a balanced diet that includes plenty of fruits, vegetables, lean proteins, and whole grains.

In summary, managing emotional eating is an important part of preparing for bariatric surgery. By identifying emotional triggers, developing healthy coping mechanisms, building a support network, practicing mindful eating, and making healthy food choices, you can set yourself up for success and achieve long-term weight loss goals after bariatric surgery. If you're struggling with emotional eating, consider seeking the support of a therapist who specializes in this area.

Realistic Expectations for Weight Loss Surgery Success - Interview with Ashlyn Bariatric Therapist Episode 193

If you're considering bariatric surgery or have already undergone the procedure, it's important to understand that there may be emotional challenges to navigate. Past trauma is one factor that can impact the success of bariatric surgery, and it's important to address any emotional issues that may arise during the post-surgery journey. Here are some tips for managing emotional challenges related to bariatric surgery and past trauma.

1. Acknowledge the impact of trauma: Trauma can have long-lasting effects on mental and physical health, and it's important to acknowledge the impact that past trauma may have on your current emotional state. Working with a therapist who specializes in trauma can be helpful in addressing these issues.

2. Identify emotional triggers: Bariatric surgery can trigger memories of past trauma, and it's important to identify any emotional triggers that may arise during the post-surgery journey. This may include feelings of anxiety, depression, or body image issues.

3. Develop coping strategies: Coping strategies can help you manage the emotional challenges of bariatric surgery and past trauma. This may include mindfulness techniques, relaxation exercises, and cognitive-behavioral therapy.

4. Seek support: Support from friends, family, and a therapist can be invaluable in navigating emotional challenges related to bariatric surgery and past trauma. Don't hesitate to reach out for help when you need it.

5. Embrace self-care: Self-care is an important part of managing emotional challenges related to bariatric surgery and past trauma. This may include activities such as exercise, meditation, and hobbies that bring you joy.

In summary, bariatric surgery can be an effective tool for weight loss, but it's important to address any emotional challenges that may arise, particularly if you have a history of trauma. By acknowledging the impact of trauma, identifying emotional triggers, developing coping strategies, seeking support, and embracing self-care, you can navigate the emotional challenges of bariatric surgery and past trauma and achieve long-term success.

Benefits of Counseling Before and After Bariatric Surgery

Obesity is a multifaceted and chronic medical condition that affects millions of individuals worldwide. It is frequently associated with comorbidities such as diabetes, hypertension, and heart disease. Weight loss surgery, such as gastric sleeve or RNY gastric bypass, has emerged as a popular treatment option for individuals struggling with obesity. However, bariatric surgery is not a standalone solution and necessitates comprehensive care that includes bariatric counseling.

Bariatric counseling is an indispensable component of a comprehensive weight loss program, particularly for those who have undergone weight loss surgery. It entails working with a qualified counselor who specializes in bariatrics to address the emotional and psychological aspects of obesity, including the triggers that contribute to overeating and other maladaptive behaviors. Bariatric counseling can also provide invaluable support during the recovery process and assist patients in maintaining their weight loss over the long term.

One of the principal benefits of bariatric counseling is improved mental health. Research has demonstrated that individuals with obesity frequently grapple with depression, anxiety, and low self-esteem, which can be exacerbated by the challenges of weight loss. Bariatric counseling can aid patients in working through these emotions and developing coping mechanisms to manage stress and maintain a positive mindset. Improved mental health can lead to better overall quality of life and greater success in weight loss endeavors.

Another benefit of bariatric counseling is enhanced adherence to the weight loss program. Bariatric surgery necessitates significant lifestyle changes, including dietary modifications and increased physical activity. These changes can be challenging to maintain without the appropriate support. Bariatric counseling provides patients with the tools and strategies they require to stay on track and achieve their weight loss goals.

Bariatric counseling can also help patients address underlying issues that may contribute to weight gain, such as emotional eating, poor body image, and lack of motivation. By working with a counselor, patients can identify these issues and develop strategies to overcome them, which can lead to more successful weight loss outcomes.

Moreover, bariatric counseling can assist patients in preparing for weight loss surgery and managing the recovery process. It can also provide ongoing support as patients adapt to their new lifestyle and maintain their weight loss over the long term. With the proper counseling and support, patients can achieve enduring weight loss and improved health outcomes.

In conclusion, bariatric counseling is a crucial component of a comprehensive weight loss program, particularly for individuals undergoing weight loss surgery such as gastric sleeve. It can provide patients with the emotional and psychological support they need to surmount the challenges of weight loss and achieve lasting success. If you or someone you know is struggling with obesity, consider seeking the help of a qualified bariatric counselor to support your weight loss journey.

How To Be Successful in Your Bariatric Surgery Evaluation

There are no cookie-cutter examples of a successful evaluation, but there are things you can do to help your success.

Attitude

There are sound and valid reasons why a psychological evaluation is mandatory for bariatric surgery patients. Besides being required by your doctor and insurance company, the assessment is there to make sure you are successful in the long term.

“Psychological evaluation of patients before bariatric surgery is a critical step, not only to identify contraindications for surgery, but also — and more so — to better understand their motivation, readiness, behavioral challenges, and emotional factors that may impact their coping and adjustment through surgery and the associated lifestyle changes.” – Snyder, 2009

The evaluation can be invasive and uncomfortable, but it requires your cooperation. Coming in with the belief that the evaluation is a waste of time won’t help you, and it can be indicative of a resistance to follow up when you need help later.

Be Prepared

To move the evaluation process along as fast as possible, prepare in advance.

·        Complete the required paperwork

·        Bring a list of the prescription medication you are taking

·        Bring your Insurance cards

·        Think about the people who will be in your support network

·        Prepare a list of goals in advance, or consider the reasons why you want the surgery

Be Honest

The uncomfortable nature of the evaluation can make being honest difficult. Some patients may fear that their responses are being over-interpreted or that things will be taken out of context. That is not what this assessment is about.  This evaluation is meant to make sure that you have what you need to have the best possible surgical outcome. 

Ask Questions

The evaluation is your chance to ask questions about the process, where to find help if you need it, or even learn about bariatric surgery itself. It can go a long way towards showing how much you are considering the implications of surgery if you ask questions.

Sources

Snyder A. G. (2009). Psychological assessment of the patient undergoing bariatric surgery. The Ochsner journal, 9(3), 144–148. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096263/

What Should I Expect During My Bariatric Evaluation?

The American Society for Bariatric Surgery lays out, pretty clearly, the suggestions for pre-surgical psychological assessment of bariatric surgery candidates. All of the questions asked during the evaluations originate from this document: https://asmbs.org/app/uploads/2014/05/PsychPreSurgicalAssessment.pdf

Topics of discussion for the evaluation process include:

• Behavioral Evaluation

  1.      Diet

  2.      Exercise

  3.      Drug/Alcohol Use

  4.      Medical Non-Compliance

  5.      Legal History

• Cognitive and Emotional Evaluation

  1.      Cognitive Issues

  2.      Checking Your Understanding

  3.      Psychological History

• Evaluation of Present Situation

  1.      Stress

  2.      Social Support

• Motivation and Expectations

  1.      Your Motivation

  2.      Education on Your Chosen Surgery Type

An overview of the evaluation you will go through is below. Once that evaluation is completed, you will be informed of any additional treatment that is needed before you can be cleared for surgery, this isn’t a very common occurrence, but does happen from time to time if mental health concerns are not being treated. A report with insurance required information will be prepared and sent to your surgeon’s office, usually same day.

The Evaluation

Behavioral Evaluation

1. Diet

During the evaluation, you will be asked about any previous attempts at weight loss. Many people may be ‘professional dieters’ and have tried nearly every diet they could find. Insurance companies want specific names, so please be patient and try your best to remember the names (if they have one) or the specifics of the diet. Most of the time, based on the description, it can be determined which diet you are referring to.

With this, eating styles will be discussed, including problematic eating patterns (night eating, binge eating, etc.). You will be asked about the ways that you have attempted to correct these problematic behaviors.

2. Exercise

Similar to diet, you will be questioned on your past and current physical activity habits. This is an excellent area to talk over any physical limitations you may have due to health problems.

3. Drug/Alcohol Use

You will be asked about your drug and alcohol use, and if your usage has ever led to addiction. Past addiction to drugs or alcohol will not disqualify you from bariatric surgery, but due to the high probability of cross addiction and the increased stress, your likelihood for relapse needs to be assessed. Be prepared to talk about what you are doing to remain sober and where you will go for help if the urge to return to prior addictions becomes overwhelming.

4. Medical Risk Taking Behaviors

Bariatric surgery requires strict adherence to the guidelines the surgeon will give to you. Following these guidelines is for your safety. This is why the evaluation will include questions on any previous or current health issues and how well you are complying with doctor’s orders.

5. Legal History

A long history of legal problems is indicative of impulsive behavior patterns. Having a criminal record won’t exclude you from undergoing bariatric surgery, but expect to be asked about what you learned and how you plan to avoid legal problems in the future. If you are having current legal complications, it may not be the best time for you to go through the surgery.

Cognitive and Emotional Evaluation

1. Cognitive Issues

You need to understand the implications of bariatric surgery. If there are any learning difficulties or issues with cognitive functioning, these should be addressed before the surgery so the right people can be brought in to help you better understand everything. This includes language barriers so that the surgeon is aware to provide you with educational materials in your language of comfort.

2. Checking Your Understanding

During the evaluation, you will be asked to identify, in simple terms, what the surgery will do to your body. You will be expected to know how bariatric surgery will work to help you lose weight, and the changes you will need to make after surgery to be successful. Your explanations do not need to be detailed, but you should understand the basics. The details will be covered after your understanding is assessed.

3. Psychological History

Having prior issues with your mental health will not make you ineligible for bariatric surgery. It is important going forward that these issues are brought up to better help you cope with things you may face during recovery. You will be asked about any mental health treatment you have gone through, how that treatment was sought out, and if you completed that treatment.

Your present mental health will also be evaluated. Prepare a list of any current medications or ongoing treatment. If you are experiencing psychosis, debilitating depression or anxiety, or any other severe mental health issue at the time of the evaluation, it will be in your best interest to delay bariatric surgery and obtain treatment. 

Past trauma will also be discussed because of the high association of trauma victims and obesity. This would include abuse or neglect in your childhood, military experience, or domestic violence. Additional therapy may be recommended as part of your recovery.

Evaluation of Present Situation

1. Stress

We all struggle with stress sometime in our life. In the interest of ensuring that you have the best possible surgical outcome, you will be asked about events occurring in your life that may be causing you stress. If these events are consuming your life, the concern is that you may not be able to focus on recovery.

2. Social Support

Having a network of friends and family willing to help you through the recovery process and beyond will be vital to your long term success. For this reason, a conversation regarding people who can support you through the bariatric surgery recovery period will be a part of the evaluation. If you have friends or family members who have gone through bariatric surgery, be sure to bring this up when discussing your support system.

Motivation and Expectations

1. Your Motivation

Motivation can come from many many places, but for the bariatric surgery process, the most important source of motivation comes from you. It can be challenging to maintain the needed motivation for years after the surgery, so you will be asked what is driving you to succeed. It can be helpful if you spend some time thinking about this in advance, and prepare a list of things you hope to accomplish with the surgery. These internal motivating factors could be (but not limited to) related to your improved health, increased physical ability, or becoming able to live your life again.

External motivation can come from people in your support network, but these things may change over time. If you are going through bariatric surgery to please someone else, you may find yourself disappointed in the future and face a relapse back into old habits.

2. Education on Your Chosen Surgery Type

Knowledge regarding the type of bariatric surgery you are considering going through is needed for you to make the best choices. You may have one or two preferred surgery methods in mind. Part of the evaluation process will be focused on providing you with some details to make sure that you understand the surgery and what will be expected of you.

Before Your Appointment

Schedule Your Appointment

Scheduling your appointment on my website is easy, just pick a date that you want to be seen, chose a time, and input  your information. This is the quickest way to get your evaluation appointment made. Click on the ‘Make An Appointment’ tab to begin the scheduling process.

After you make your appointment and fill out the required information, I will reach out to you so that I can answer any questions you may have. During that call, we will discuss information regarding your insurance coverage, deductibles, co-pays, and payment options. You will need to put down your credit card information to hold the appointment. Nothing will be charged without your knowledge, and not until after the evaluation has been completed, unless you do not show up for your scheduled appointment.

Prepare in Advance

Before your appointment, make sure you fill out all of your paperwork in the online portal. This paperwork can take an hour or longer to complete, so please be prepared to take the time to answer all of the questions. Filling this out in advance can help the process move along faster, and it will get you out of the office quicker. Do your best to answer all of the questions. If there is something you aren’t sure about, make your best guess and make a note to discuss it with us during your intake exam.

The Appointment

Arrive at the office early to make sure you can find the building and suite. If you are running late, please call or text. There is enough time during this first meeting to complete the evaluation, so if you are going to be over 30 minutes late, the appointment will have to be rescheduled. You will most likely know the outcome of your assessment before you leave. If any other follow up is needed, a plan will be made before leaving the office.

You will receive notice when the evaluation is sent to your provider. All evaluations are sent by HIPPA compliant fax directly to your surgeon’s office. HIPPA regulates that your evaluation cannot be directly released to you because of safety concerns, but it will be sent directly to your surgeon’s or primary care provider’s office.