Download My Bariatric Solutions

My Bariatric Solutions
Patient Education Handbook
Decatur • Keller • Dallas
www.MyBariatricSolutions.com
Patient Education Handbook
Table of Contents
Important Contact Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
About Us . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Chart Your BMI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi
Important Dates Regarding My Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Post Surgery Appointments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Overview of Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-3
Preparing for Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Personal Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Mediciations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Alcohol and Tobacco . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-5
Return to Work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
If You Are Ill Before Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Dietary Behavior Changes to Make Prior to Your Surgery . . . . . . . . . . . . . . . . . . . . . 6
Pre-operative Low Calorie Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Pre-operative Low Calorie Diet Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Pre-operative Low Calorie Diet Sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Pre & post-operative liquid diet for Diabetic Patients . . . . . . . . . . . . . . . . . . . . . . . . . 9
Suggested Medication Protocol for Diabetics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Pre-op Full Liquid Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Pre-op Clear Liquid Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Pre Surgery Grocery List . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Hospital Pre-admitting Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
What to Bring to the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Your Surgery Day . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Personal Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
General Surgical Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Hospital Admitting Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
The Operating Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
The Recovery Room . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Your Hospital Stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Exercises that Speed Your Recovery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Pain Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Diet at the Hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Going Home . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Patient Education Handbook i
Patient Education Handbook
Home Again . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Checking In . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Specific Recovery Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Personal Hygiene . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Bandages & Wound Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Caring for Incisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Pills & Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Medications to Avoid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Driving . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Vitamin/Mineral Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Vitamin/Mineral Brand Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Starter Kit Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Medical Concerns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Urgent Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Normal Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Home Pharmacy Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Nausea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Vomiting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Dehydration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Bowel Habits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Constipation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Diarrhea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Gas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Indigestion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Lactose Intolerance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Drainage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Hernias . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Thrush/Yeast Infections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Transient Hair Loss/Skin Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Scars . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Sexuality/Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Dumping Syndrome (gastric Bypass only) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Long Term Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
LAP-BAND® Patient Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Patient Education Handbook ii
Patient Education Handbook
What We Have Learned from Experience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Eating Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Recognizing Fullness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Goal Buster Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Lifetime Dietary Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Power of Protein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Post Surgery Diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Week 1- Clear Liquid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Week 2 - Full Liquid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Weeks 3 & 4 - Soft Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Week 5+ - Regular Foods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Social Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Exercise . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
First Steps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Starting an Exercise Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Loss of Bone and Muscle Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
Ten Tricks for Sticking with the Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
The Walking Workout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Water Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Choosing a Personal Trainer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Walking Program After Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
After Surgery Workout Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Workout Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Instructions for Borg Rating of Perceived Exertion (RPE) Scale . . . . . . . . . . . . . . . 49
Long Term Success . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Follow-up Physician Visits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Labs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
Expected Weight Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
The 8 Rules of Weight Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Emotional Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Emotional Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Counseling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Family and Friends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Body Image . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Support Group Meetings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Journal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56–60
Patient Education Handbook iii
I mportant contact in f ormation
Always contact your surgeon or doctor first! The staff at My Bariatric
Solutions is here to help guide you to successful weight loss through medical
treatment or surgery.
Patient Education Handbook iv
A B O U T M y bariatric solutions
Thank you for choosing My Bariatric Solutions to assist you in achieving your health and fitness goals. We
sincerely appreciate your business and we promise to do everything that we can to meet and exceed your expectations. Our goal is to be the “Cadillac” of Weight Loss Surgery Programs by providing you with a level of care
and attention that is unmatched.
My Bariatric Solutions employs a TEAM of professionals that are here to assist you in your weight loss journey
and to provide you with a smooth and rewarding experience. Our team of professionals include: Weight Loss
Surgeons with over 12 years of experience, Certified Bariatric Nurses trained in caring for the weight loss surgery
patient, Registered Dietitians experienced in making eating after weight loss surgery fun and healthy, Exercise
Specialists to show you how to exercise, Insurance and Financial Specialists to take care of any financial concerns
you may have, and Patient Representatives to make your experience as smooth as possible. These professionals
are here to help you in your journey, so never hesitate to contact them should you have a question or concern.
Please rest assured that you are not in this alone and please let us help you whenever possible.
In addition to providing you with a TEAM of professionals, My Bariatric Solutions strives to ensure that you are
well educated about how your surgery works and how you can work with the surgery to achieve the best results
and prevent complications. Our philosophy is that a well educated patient equates to a successful patient. As part
of your weight loss surgery education you will learn: how your surgery works, potential complications of surgery
and how to prevent them, how to eat before and after surgery, how to change bad habits to good behaviors, the
best way to exercise, and much more. This education book is part your education experience. Please review it
in detail and our health professionals will contact you prior to surgery to ensure that you comprehend all of the
information discussed herein and to answer any questions or concerns that you may have.
As you can see, My Bariatric Solutions provides complete and personalized care for the weight loss surgery
patient. As a result of the superb care that we provide, My Bariatric Solutions has been awarded the following
certifications: Center of Excellence in Bariatric Surgery by the American Society of Metabolic and Bariatric
Surgery (ASMBS), Certified LAP-BAND® TOTAL CARE PROGRAM, a United Health Care OptumHealth
Clinical Sciences Institute Bariatric Center of Excellence a Cigna 3 Star Quality Program, and a Blue Distinction
Center for Bariatric Surgery.® This certification proves that MyBariatric Solutions doesn’t just talk the talk, but
that they also walk the walk. The patients that choose My Bariatric Solutions achieve quality results and have an
experience that they are excited to share with others. So, congratulations on your decision and always remember
that we are here to serve you.
In Good Health,
The Staff at My Bariatric Solutions
Patient Education Handbook v
Chart your BMI
Weight
100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280 290 300 310 320 330
5'1
20
19
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21
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23
25
25
27
27
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31
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35
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39
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43
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47
45
49
47
51
49
53
51
55
53
57
55
59
57
61
59
63
61
65
65
5'2
18
20
22
24
26
27
29
31
33
35
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40
42
44
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48
49
51
53
55
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5'3
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25
27
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30
32
34
36
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39
41
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44
46
48
50
51
53
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5'4
17
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21
22
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26
28
29
31
33
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36
38
40
41
43
45
46
48
50
52
53
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57
5'5
17
18
20
22
23
25
27
28
30
32
33
35
37
38
40
42
44
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48
50
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53
55
5'6
16
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26
27
29
31
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34
36
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40
42
44
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49
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53
5'7
16
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22
24
25
27
28
30
31
33
35
36
38
39
41
42
44
46
47
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50
52
5'8
15
17
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20
21
23
24
26
27
29
30
32
34
35
37
38
40
41
43
44
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50
5'9
15
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18
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21
22
24
25
27
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30
31
33
34
36
37
38
40
41
43
44
46
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49
5'10 14
16
17
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20
22
23
24
26
27
29
30
32
33
35
36
37
39
40
42
43
45
46
47
5'11 14
15
17
18
20
21
22
24
25
27
28
29
31
32
34
35
36
38
39
41
42
43
45
46
6'0
14
15
16
18
19
20
22
23
24
26
27
29
30
31
33
34
35
37
38
39
41
42
43
45
6'1
13
15
16
17
19
20
21
22
24
25
26
28
29
30
32
33
34
36
37
38
40
41
42
44
6'2
13
14
15
17
18
19
21
22
23
24
26
27
28
30
31
32
33
35
36
37
39
40
41
42
6'3
13
14
15
16
18
19
20
21
23
24
25
26
28
29
30
32
33
34
35
36
38
39
40
41
6'4
12
13
15
16
17
18
20
21
22
23
24
26
27
28
29
30
32
33
34
35
37
38
39
40
height
5'0
Underweight
Healthy Weight
Overrweight
Obese
Severely Obese
Tracking Your BMI
Before Surgery: BMI_________ Date________
One Month Post Surgery: BMI_________ Date________
3 Months Post Surgery:
BMI_________ Date________
6 Months Post Surgery:
BMI_________ Date________
9 Months Post Surgery:
BMI_________ Date________
12 Months Post Surgery:
BMI_________ Date________
Patient Education Handbook vi
Important Dates Regarding Scheduling My Procedure
(for personal use only)
Please note these dates are for my personal use only. The only person that can provide me with surgery dates
is my Surgery Scheduler. Surgery Scheduler has to confirm there are Operating Rooms available, therefore I
may not be guaranteed my requested surgery date. I know that I will will not be contacted by a Surgery Scheduler
until all pretesting requirements have been completed, received, and reviewed by the surgeon. The surgery
schedule fills up fast so please contact My Bariatric Solutions if you have any trouble getting your pre-testing
requirements completed.
Pre-testing appointments
q Psych Evaluation
Date:
q Online Education
Completed On:
Time:
Location:
You can access our online education program through our website: www.MyBariatricSolutions.com. Scroll
all the way to the bottom of the home page and you will see this link:
Click on it and
enter your username and passwork listed below and it will take you
directly into your education program. It should take you about 20-30 minutes to complete it. You'll watch a video and answer
the questions following. The education course is procedure specific, please be sure to complete the correct
course based on the procedure you are planning to proceed with.
q Diet Education Completed on:
q Cardiology Clearance Date:
q Sleep Study
Date:
q General Surgeon Consult Date:
q EGD
Date:
q 1st Diet Follow-up Date:
q
Date:
Time:
Location:
Time:
Location:
Time:
Location:
Time:
Location:
Time:
See next page for other diet appointments
Time:
Location:
surgery dates
q Surgery Date:
q Pre-op Appointment with Dr. Stowers: Date:
q Pre-op Appointment with hospital Date:
Time:
Time:
Go to 2nd floor of Fit-N-Wise entrance (far left entrance of the main hospital (revolving door) take a right off of
the elevator and the pre-op admissions office is to your immediate right.
Patient Education Handbook vii
Post surgery appointments
1st Lap-Band Adjustment
Date:
Time:
Location:
1st Follow-up Appointment Date: Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Diet follow-up appointments
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Follow-up Appointment Date:
Time:
Location:
Patient Education Handbook viii
Patient Education Handbook ix
Overview of Pro cedures
©2006, Ethicon Endo-Surgery Inc.
The Normal Digestive Process
Normally, as food moves along the digestive tract,
appropriate digestive juices and enzymes arrive at the
right place at the right time to digest and absorb calories
and nutrients. After chewing and swallowing the food,
it moves down the esophagus to the stomach, where a
strong acid continues the digestive process. The stomach
can hold about three pints of food at one time. When the
stomach contents move through the outlet of stomach
to the duodenum, bile and pancreatic juice speed up
digestion. Most of the calcium and iron in the foods we
eat is absorbed in the duodenum. The jejunum and ileum,
the remaining two segments of the nearly 20 feet of small
intestine, complete the absorption of almost all calories
and nutrients. The food particles that cannot be digested
in the small intestine are stored in the large intestine until
eliminated.
Patient Education Handbook 1
Sleeve Gastrectomy
The Sleeve Gastrectomy is a surgery performed only on
the stomach and does not involve any surgery on intestines
(which would make it malabsorptive) Sleeve Gastrectomy
has also been called Partial Gastrectomy and Vertical Sleeve
Gastrectomy and Gastric Sleeve. It basically consists of
making a stomach that looks like a pouch into a long tube;
therefore the name “sleeve.” The Sleeve Gastrectomy removes
two thirds of the stomach, which provides for quicker satiety
and decreased appetite. The smaller stomach pouch restricts
food intake by allowing only a small amount of food to be
eaten at one time. After the separation of the stomach into a
smaller tube, the remainder of the stomach is removed. The
valve at the outlet of the stomach remains; this provides for
the normal process of stomach emptying to continue which
allows for the feeling of fullness. If you eat too quickly, take
large bites of food, drink fluids with meals/snacks, eat dry,
tough, or sticky foods, can result in vomiting or discomfort.
LAP-BAND
©2006, Ethicon Endo-Surgery Inc.
Restrictive Procedures
Restrictive procedures are weight loss surgeries that
function by restricting how much food it takes to become
and stay full. A restrictive weight loss surgery procedure will
cause you to become satisfied with smaller portions and as
a result you will lose weight because your body will burn
more calories than you consume on a daily basis. The most
common Restrictive Weight Loss Procedures that surgeons
perform are the LAP-BAND® and the Gastric Sleeve (Sleeve
Gastrectomy) Procedures.
LAP-BAND® System
The LAP-BAND® procedure involves placing a band around
the upper part of the stomach. (The band is filled by adding
saline fluid through a port that lies under the skin of the
abdomen.) These anatomical changes function to provide
a sensation of fullness after a very small meal and reduce
hunger between meals. While not common, excessive
vomiting can result in LAP-BAND® patients if they eat
too quickly, take large bites of food, drink fluids with their
meals/snacks, eat dry, tough, or sticky foods, or have their
band adjusted to where it is too tight. If these things are not
done then excessive vomiting should not be an issues in the
LAP-BAND® patient.
Patient Education Handbook 2
Sleeve Gastrectomy
©2006, Ethicon Endo-Surgery Inc.
GASTRIC BYPASS
Combination Procedures: Restrictive
and Malabsorbptive
The Roux-en-Y Gastric Bypass
The Roux-en-Y Gastric Bypass can be regarded as a restrictive procedure, however, there is some malabsorption due to
bypassing food around the part of the small intestine which
includes the duodenum and the initial part of the jejunum.
The risk for pouch stretching, breakdown of the staple lines,
and leakage of stomach contents into the abdomen are about
the same for Gastric Bypass as for vertical banded gastroplasty. However, because Gastric Bypass causes food to skip
the duodenum, where most iron and calcium are absorbed,
risks for nutritional deficiencies are higher. Anemia may
©2006, Ethicon Endo-Surgery Inc.
result from malabsorption of Vitamin B-12 and iron in
menstruating women, and decreased absorption of calcium
may bring on osteoporosis and metabolic bone disease.
Patients are required to take life-long nutritional supplements that usually prevent these deficiencies. Gastric Bypass
may cause dumping syndrome, whereby stomach contents
move too rapidly through the small intestine. Symptoms
include nausea, weakness, sweating, faintness, and occasionally diarrhea after eating, as well as the inability to eat sweets
without becoming so weak and sweaty that the patient must
lie down until the symptoms pass.
Patient Education Handbook 3
P reparing f or S urgery
Personal Preparation
Now that you have decided to proceed with surgery, there
are certain steps to take before your operation to ensure
that you are as prepared as possible for the procedure. Start
taking multivitamins daily to improve your general health.
Further, take 500 mg of Calcium Citrate two times daily.
Vitamin and mineral intake is especially important after
bariatric surgery in order to maintain good nutrition and
health. We have found that if you start taking these supplements before surgery, it will be easier remembering them
after surgery. Another important way to prepare for surgery
is exercise. The best time to begin your exercise program is
before your surgery. We’re not kidding. The sooner you start
exercising the easier it will be after you have had surgery.
Success with weight loss surgery is all about choosing the
right habits, with the support of the surgery to improve
your success. We want you to start moving more, but we
don’t want you to injure yourself. Walking on a daily basis
improves your circulation and makes breathing easier
during your recovery. You will also benefit from having a
plan in place, so you don’t have to figure out your exercise
routine during your recovery phase. A pedometer is a
recommended purchase to keep you informed of your
walking progress. If you are unable to walk daily due to
joint pain, then you may want
to look into an aquatic program
at Wise Regional Health System
or a class close to you. Every
town has classes for arthritic or
cardiac patients that are held in
a safe and clinical environment.
Water exercises will condition
your breathing, but are not
weight bearing and are therefore
easier for people who have joint
problems. Good skin integrity
is essential for the operative site. It is important to maintain
good hygiene, by keeping skin clean and dry, especially in
the days before surgery. Skin breakdown could possibly
cause your surgery to be delayed.
Medications
Your surgeon may ask you to stop taking particular
medications for at least 10 days prior to surgery. Some
particular medications include all diet pills, blood thinners,
Patient Education Handbook 4
and NSAIDs, such as Ibuprophen and Aspirin need to be
discontinued a minimum of ten days prior to surgery. The
use of diet pills within two weeks of surgery will cause
your surgery to be cancelled. Herbal medications such
as St. John’s Wort, Gingko Biloba, Garlic, etc, should be
discontinued, as these have blood-thinning properties.
Other herbal supplements such as Kava and Valerian Root
are known to interact with anesthesia and should also be
stopped at least 10 days before surgery. Again, remember
to tell your surgeon all the medicines and nutritional
supplements you are taking. Do not forget to check the
label of your multivitamin; many times they can contain
herbal supplements as well. Remember to check all labels of
over-the-counter medicines, since certain over-the-counter
medicines can contain aspirin, too. If in doubt, please talk
with your pharmacist or your surgeon.
Alcohol and Tobacco
Alcohol causes gastric irritation and can cause liver damage.
During periods of rapid weight loss the liver becomes
especially vulnerable to toxins such as alcohol. You may find
that only a couple of sips of wine can give you unusually
quick and strong effects of alcohol intolerance. In addition,
alcoholic beverages are high in empty calories and may
cause “dumping syndrome” in the gastric bypass patient. For
these reasons, we recommend complete abstinence from
alcohol for one year after surgery and avoiding frequent
consumption thereafter.
Since smoking hinders proper lung function, it can increase
the possibility of anesthetic complications. Smoking can
increase your risk of complications such as deep vein
thrombosis (blood clots in the legs). Smoking also reduces
circulation to the skin and impedes healing. Patients are
required to stop smoking eight weeks before surgery.
Smokers who undergo anesthesia are at increased risk for
developing an infection and cardiopulmonary complications
(such as pulmonary embolism, pneumonia and the
collapsing of the tiny air sacs in the lungs). Besides the
well-known risks to the heart and lungs, smoking stimulates
stomach acid production, leading to possible ulcer
formation. Patients must agree to permanently refrain from
smoking after surgery. Ask your Primary Care Physician
and/or surgeon to write you a prescription for a smoking
cessation aid, if necessary.
Our Final Answer
NO SMOKING!
We know you have heard this before,
but it is really an important part
of your recovery. Smoking causes
narrowing of your blood vessels
that in turn decreases circulation.
This decrease in circulation interferes with your ability to heal
correctly. This inability to heal properly can increase your
risk of developing an incisional hernia among other things.
Smoking can also cause you to have problems with your ability
to breathe on your own after you have been under anesthesia
and may require you to remain intubated (mechanically assisted
breathing) for a longer period of time post-surgically.
Again, if you smoke you will need to stop as soon as possible.
Please ask your primary care physician for information on
smoking cessation drugs and programs. Take care of this
now and do not wait until surgery to decide to quit!
Recent research shows that smoking is prevalent among
surgical weight loss candidates. This is not surprising
considering that most surgery candidates look for
another addictive substance to satisfy their emotional
needs whenever they diet. Often, obese individuals will
replace their favorite food with a cigarette in an effort to
lose weight while simultaneously calming their nerves.
As patients complete their education they are confronted
with our smoking policy which is simply: YOU MUST
STOP SMOKING NOW IN PREPARATION FOR SURGERY
AND YOU ARE NOT TO RESUME SMOKING EVER –
EVEN AFTER SURGERY.
Not surprisingly, this policy is frequently met with anxiety,
fear, and sometimes even silent refusal. We all know of
someone who waited until the day before surgery to put
down the cigs, or someone who quit well prior to surgery,
but who resumed soon thereafter. Most patients know that
smoking is bad for them and that they should stop smoking
for the good of their own health; however, some patients
fail to truly grasp why it is so vital for weight loss surgical
patients to avoid butts prior to surgery and for the rest of
their lives. There are many reasons to stop smoking, but
here are out top 4 reasons applicable to weight loss surgery
patient:
1. Smoking Impairs Wound Healing. Patients who don’t stop
smoking well prior to surgery & patients who resume
smoking soon after surgery are at a very high risk for
complications because smoking decreases the amount of
oxygen that flows to the incised tissue. Obviously, wound
incisions require plentiful amounts of oxygen to heal
appropriately; therefore, smoking will impede this process
wound infection and could leave you with a wound like
this. Do you really want to risk it?
2. Smoking Damages The Lungs. This predisposes surgical
patients to numerous complications to include:
Pneumonia, anesthetic complications, blood clots, &
possibly respiratory failure with the need for ventilator
support. All of these are Life Threatening Emergencies!!
3. Smoking After Surgery Predisposes Surgical Patients
to bleeding ulcerations of the pouch, severe gastritis
& LAP-BAND® erosion into the stomach. Smoking
increases the amount of stomach acid that the stomach
produces & surgery reduces the ability of stomach
tissue to heal due to decreased oxygen delivery. This
combination makes weight loss surgery patients who
continue to smoke prone to these GI complications.
4. Smoking Significantly Impedes Weight Loss After Surgery.
Smoking decreases the amount of oxygen delivered to
all cells. Oxygen is required to convert fat into energy.
Therefore, smokers will experience difficulty achieving
their weight/fat loss goal.
Return to Work
Expected return to work time is about 1 to 2 weeks. This
may vary greatly. The time you take off from work depends
on many things such as the kind of work you do, your
general state of health, how badly your work needs you, how
badly you need your work (i.e. the money), your general
state of motivation, the surgical approach (laparoscopic
versus open) and your energy level. It is important to
remember that you are not just recovering from surgery,
but you are eating very little and losing weight rapidly. You
may have heard that someone went back to work full time
in just a few days. We would, however, caution you not to
rush back to full time work too quickly. The first week is
a precious time to get to know your new digestive system,
to rest and exercise. If financially feasible, take this time
to focus on your recovery. Some patients do not wish to
tell the people with whom they work what kind of surgery
they are having. It is perfectly appropriate to tell as much
or as little to your employer as you would like. Although
you do not need to tell your employer that you are having
weight loss surgery, it is recommended to reveal that you are
having major abdominal surgery. Explain that you will need
one or more weeks to recover. Your employer should have
the relevant forms for you to complete. You may want to
indicate that you will not be able to do any heavy lifting for
one month after surgery.
Patient Education Handbook 5
If You Are Ill Before Surgery
Should you develop a cold, persistent cough, fever, skin breakdown or any changes in your condition during the days before
your surgery, please notify the surgeon immediately. You will
need to be re-evaluated for surgical readiness. You need to be
in the best possible shape for anesthesia. Scheduling can be
adjusted to your condition if necessary.
after your meals as this can interfere with weight loss and
possibly increase risk of vomiting. Most of your liquids
from here on out should come from low-calorie sources
such as water, green tea, Crystal Light, unsweet tea,
Propel Zero. Remember the phrase Eat Your Calories/
Don’t Drink Your Calories!
6. Dietary Behavior Changes to Make
Prior to Your Surgery
Research has shown that patients who adhere to the
following Dietary Guidelines after weight loss surgery lose
significantly more weight and experience significantly
fewer complications than those patients who do not. We
encourage you to begin making these Dietary Behavior
Changes now (before surgery) as they will be difficult to
change if you wait until after surgery to try and make these
changes.
1. EAT PROTEIN at EACH MEAL & AT THE
BEGINNING OF EACH MEAL. Examples of protein
include: boneless/skinless chicken thigh, lean red
meat, any grilled/baked fish, low fat cottage cheese,
low fat string cheese, high protein meal replacement
shakes (Bariatric Advantage, Myoplex Light, EAS
AdavantEDGE Carb Control).
2. Eat slower (20 to 30 minutes per meal). To help you
slow down your pace of eating we suggest that you:
• Use baby utensils
• Put utensil down between each bite
• Chew 20 to 30 times per bite
• Avoid distractions like TV
3. Eat more frequently (every 3 to 4 hours).
Consume 3 small meals with 2 high protein snacks
between your meals. Example:
cheese, nuts, protein bars, cottage
chesse with fruit, and Greek
yogurt with fruit
4. Never Skip BREAKFAST!
Use a high protein/low
carbohydrate meal replacement
shake if you find it difficult to
consume solid foods at breakfast
(such as a Bariatric Advantage
Meal Replacement Shake)
5. Liquids. Do not drink liquids 30 minutes before or
Patient Education Handbook 6
REDUCE INTAKE OF
SOFT FOODS (ice cream,
Ritz crackers, creamed
soups). Soft foods can
allow you to consume more
calories as they do not
provide fullness.
7.
TAKE VITAMINS &
MINERALS DAILY
We suggest Bariatric Advantage.
8. NO CARBONATED BEVERAGES. These beverages
can slow down your weight loss, stretch your gastric
pouch, and cause heartburn/stomach discomfort
9. LIMIT SUGARS (Especially gastric bypass) such as
a. Lactose
b. Fructose
c. Sorbitol
d. Corn syrup
* C
an consume foods made with artificial or natural
sweeteners such as Saccharin, Aspartame, Splenda, or
Stevia/Truvia.
* A
void items artificially sweetened with sugar alcohols
which may cause a laxative effect. Usually a warning
is on the label of products that contain sugar alcohols.
They will cause dumping in gastric bypass patients.
Pre-operative Low Calorie Diet
at least 2 weeks prior to your surgery You need
to start a low calorie diet (1,200 calories per day for women
and 1,300–1,500 calories per day for men) It is preferable if
you start this diet tomorrow to get a jump start.
There are a number of reasons why it is important for you to
comply with this recommendation such as:
1. This diet will help shrink your liver. Most
all obese patients have what is called a fatty liver. A fatty
liver is just that…a liver that has a lot of fat in it. A fatty
liver alone is bad for you as it can cause poor digestion,
contribute to high triglyceride levels, and may eventually
lead to cirrhosis of the liver. A fatty liver becomes even
more troublesome when you undergo weight loss
surgery. This is due to the fact that the liver lies directly
on top of the stomach (which is the primary area that will
be operated on). When your surgeon performs weight
loss surgery he has to use a special instrument to lift up
your liver and pull it and hold it away from the stomach
so that he/she can get a clear view of the area that they
are operating on. If your liver is too big (as a result of
having too much fat in it) at the point of surgery then
the operation becomes riskier and potentially more
complicated due to the fact that it becomes VERY difficult
to hold the liver up and out of the way. Research has
shown that people who have a fatty liver at the point of
weight loss surgery end up being in the operating room
for ~ 20 minutes longer than those patients who have
resolved their fatty liver prior to surgery. As you well
know, the longer you are under anesthesia, the greater the
risk of complications.
2.
Following a low calorie diet will get you ac-
customed to the portion sizes of food that you will be able
to tolerate after surgery and for the rest of your life. It’s
wise to start making that mental adjustment now.
3. Following a healthy low calorie meal plan
will get you in the habit of developing shopping lists and
planning/preparing your foods ahead of time. Obviously
implementing such techniques now will help you succeed
long-term.
The following suggestions will help you consume a healthy
1,200 calorie diet.
4. C
hange the types of carbohydrates
that you consume from refined to healthier/
more complex choices such as: beans, sweet potato/
yam with the skin, no-sugar or low-sugar oatmeal, light
popcorn (can use before surgery but not after), brown rice,
100% whole wheat bread, and whole fruit. Avoid refined
carbohydrates such as: white starches (bread, pasta, rice,
pancakes, muffins, cakes, etc…) fruit juice, milk, soft
drinks, regular sweetened tea/coffee, plain Gatorade,
Kool-Aid®, milk shakes
5. C
onsume a high protein/high fiber/low
carbohydrate meal replacement shake
(example: Bariatric Advantage Meal Replacement Shake)
in place of one meal at least
every 1 to 2 days.
6. K
eep junk food out
of the house. This will
make it easier to comply
with the new/healthier way
of eating.
7.
Monitor your
calorie intake
daily by using websites such as www.thedailyplate.
com and www.caloriecount.com. Stop eating for the
day when you have reached around 1,200 calories.
1. Avoid fried foods!
2. 1 to 2 servings of non-starchy veggies at
each meal. Examples include: broccoli, green beans,
zucchini, yellow squash, cauliflower, spinach, turnip
greens, asparagus, etc…
3. Include a small amount of healthy fat at
each meal (avocado, extra virgin olive oil, all natural
peanut butter (no hydrogenated/trans fats), raw/natural
almonds). Also consider taking 1 to 2 grams of fish oil
daily (highly recommend Krill Oil)
Patient Education Handbook 7
Pre-Operative Low Calorie Diet Sample Menus
We encourage you to design your own meal plans based on the guidelines set forth above; however, if you don’t have
time to plan things out then you can use these 1,200 calorie/day sample menus during this phase to make things easier
on you.
Pre-Operative Low Calorie Diet Sample Menus
Breakfast
Day 1 Menu
Meal Replacement Protein Drink (Bariatric Advantage,
Myoplex Lite)
A.M. Snack
Sargento light string cheese (3 pieces)
1/8th cup of whole/raw natural almonds
1 medium apple
Lunch
Chicken Salad (made with light mayo or miracle whip)
1 cup baby carrots with light ranch dressing
1 cup microwavable brown rice
P.M. Snack
1 cup Plain Greek Yogurt
½ cup sliced/fresh strawberries (blended into yogurt)
Dinner
3 oz. grilled sirloin steak
1 cup steamed squash & zucchini
1 cup fresh or frozen blueberries
Patient Education Handbook 8
Breakfast
Day 2 menu
3 hardboiled eggs
1 peach
1 cup low sugar oatmeal instant (any flavor)
A.M. Snack
Three 1 oz. slices of turkey breast meat
1 piece of Sargento light string cheese wrapped in meat
1 leaf green lettuce wrapped in meat
Light mayo or light miracle whip to flavor
1 medium apple
Lunch
4 oz. grilled chicken breast
1 cup steamed low starch vegetable (any)
1 cup red potatoes
P.M. Snack
EAS AdvantEDGE Carb Control Protein Drink
Dinner
4 oz. beef fajita mix
1 cup sautéed peppers/onions
1 oz. shredded Mozarrella cheese
1 tbsp. low-fat sour cream
Pre & Post-Op Liquid Diet Instructions for TYPE 2 DIABETIC Patients
The goals of the pre and post-op liquid diets are to shrink
your liver, to allow your stomach time to heal after surgery
and to aid in the weight loss process. While these are the
primary goals it is also important to simultaneously avoid
episodes of low blood sugar (hypoglycemia) and episodes
of high blood sugar during these diet phases. As you start
a Full Liquid Diet or Clear Liquid Diet pre-operatively, you
should experience a gradual decrease in your blood sugar.
The ideal situation is to try and wean you off of insulin by
the time of surgery if possible. Type 2 Diabetic Patients
should implement the following recommendations when
starting the Pre-op Liquid Diet and continue to adhere to
them during the post-op liquid diet phases:
• If you experience an episode of hypoglycemia (blood
sugar <70 or symptoms of fatigue, dizziness, sweating
and palpitations) then implement the Rule of 15 as
outlined below:
Step 1: Consume 15 gm of fast acting sugars (example:
4 oz. of orange/apple juice, 6 Life Savers, 3 glucose
tablets, a cup of milk, or 1 tablespoon of cake frosting/
icing)
Step 2: Check blood sugar in 15 minutes and if still
<70, continue to repeat Step 1 and 2 every 15 minutes
until blood sugar >70
Step 3: Once blood sugar >70, consume a high protein
meal replacement shake immediately to stabilize blood
sugar.
1. Check blood glucose levels every 6 hours and anytime
**If you are experiencing frequent low blood sugar
that you feel like you are experiencing an episode of low
episodes, then call your PCP immediately for
blood sugar. If you don't currently have a glucometer and
medication adjustments and then contact one of our
testing supplies then please call us and one of our physiRegistered Dietitians so that they may adjust your
cians will be happy to call in a prescription for you. **Please
diet on an as needed basis. **If you can't reach your
note that your insurance may or may not cover this, but it is
PCP then call our clinic immediately.
imperative for your health that you obtain it!
3. If you are diabetic and do not have a current primary
care provider then we will be happy to have one of our
2. If you have a Primary Care Physician then please call
physicians adjust your diabetic medication regimen
them before starting your pre-op liquid diet and inform
as needed; however, we encourage you to utilize your
them of the diet that you will be following and ask them
primary care physician first for these adjustments if
how you should adjust your diabetic medications.
you can. Please feel free to call us as needed.
Let them know that we recommend that diabetics implement the following protocol, but it is your doctor's decision
on how to adjust your medications and you must follow
their recommendations.
Suggested Medication Protocol for Diabetics consuming Pre and Post-op Full and Clear Liquid Diets
• If you take any oral diabetic medications then we
suggest that you stop all of them with the exception
of Metformin (Glucophage), which may be used as
needed if blood sugar remains elevated on the liquid
diet. If you take insulin then you will likely need
to discontinue that, or significantly decrease your
dose. We suggest implementing the guidelines on
page 2 of this document, which outline how to
take your medications. **Again, you must obtain
your doctor's approval before implementing these
recommendations!
• **Do not inject insulin without
measuring your blood sugar level first!
Patient Education Handbook 9
Patient Education Handbook 10
*It should be coming
down on its own with your
current diet
*Do nothing, just monitor it
every 6 hours
*If after another 24 hours
blood sugar still >151 but
<200, then call PCP or our
office for further advice.
*If after 24 hours Blood Sugar
is still >151 but <200, increase
Metformin to 2 tabs in the
am and 2 tabs in the pm and
contniue to check blood sugar.
*If after next morning finger
stick your Blood Sugar is
still >151 but <200, increase
Metformin to 2 tabs in morning
and 1 in evening (max of 3
tablets daily) and continue to
check blood sugar every 6
hours
*Take Metformin 500mg (1 in
morning and 1 in evening).
Continue to check finger stick
blood sugar every 6 hours.
(B) Blood Sugar 151-200
*If after 24 hours your Blood
Sugar is still >201 then call
your PCP or our office to have
your insulin dosage adjusted.
*If after 24 hours your Blood
Sugar is still >201 and you
were previously on Insulin then
take 1/4 of your current insulin
in addition to your Metformin
and continue to monitor blood
sugar
*If blood sugar consistently
running >201 take Metformin
500mg (2 tabs in the morning
and 2 in the evening) &
continue to monitor blood
sugar
(C) Blood Sugar 201-249
*If blood sugar running >250
then take Metformin 500mg
tablets in the morning and take
1/4th of your old insulin dose
and call us or PCP before
4pm with your sugar reading
for medication adjustments as
needed.
(D) If finger stick Blood
Sugar > 250
Other recommendations:
1. If you take Byetta or Victoza then please let us know and we will adjust your own treatment individually or speak with your PCP for their instructions.
2. If you require the use of Insulin always use these Insulin preparations in this order of preference in order to prevent low blood sugar:
1st choice: Humalog or Novalog
2nd choice: Regular Insulin
3rd choice: Lantus Insulin
4th choice: 70/30 Insulin
5th choice: Insulin N
Pre & Post
Surgery Full
and Clear
Liquid Diets
(A) If Blood Sugar
<150
Suggested Medication Protocol for Patients Taking Insulin and/or Metformin (Glucophage) on Liquid Diets
Pre -Op High Protein Full Liquid Diet (Start 1 week before surgery)
• One week prior to surgery you need to start a high protein, low carbohydrate full liquid diet. Years of research
has shown that following this diet the week before surgery reduces risk of compliccations during your surgery.Our
number one goal is your safety! The high protein, low carbohydrate, low fat full liquid diet is designed to shrink
the size of your liver, which lies directly on top of your stomach so that the surgeon can work on your stomach.
Eating a high fat diet contributes to a fatty liver, so it is imperative to follow this diet so your liver can be shrunk in
size.
**Deviation from this diet or eating solid foods can and will result in cancellation of your surgery. This means is
the the surgeon sees solid food in your stomach during surgery, your surgery will be cancelled and could result in a
cancellation fee.
Most of our team has experienced what you are going through, so please call us if you feel like cheating. We are
here to support you!!! Remind yourself of the true purpose of the diet and how important it is for your safety
and how important having this surgery is to you. If you would like more drink options or have questions, please
contact our dietitians.
• During the Pre-op Fill Liquid Diet you should:
1. Consume 3-4 Bariatric Advantage Meal Replacement Shakes (available in the office or online),
or EAS AdvantEDGE Carb Control Shakes (available at WalMart) daily.
2. Consume at least 64 ounces of water, or water based/very low calorie beverages such as
Crystal Light daily.
3. Consume calorie free liquid as desired. Examples include:
- Broth
- Sugar Free Jell-O
- Tea and Coffee (without sugar, artificial sweetner is OK)
AVOID calorie containing liquids such as:
- Juice
- Soft Drinks
- Plain Kool-Aid
- Tea and coffee sweetened with sugar
Protein Shake
2 Scoops Bariatric Advantage Meal Replacement
High Protein powder.
8–10 oz. skim milk, light soy milk or
unsweetened almond milk
1/2 tsp sugar free flavored syrup (optional)
1–2 packets of Spenda, Stevia or Truvia (optional)
Patient Education Handbook 11
Pre -Op Clear Liquid Diet (complete day before surgery)
•The day before surgery you will need to consume clear liquids only such as:
- Crystal Light
- Tea
- Coffee
- Regular or sugar free Kool-Aid
- Broth
- Gatorade
- Powerade
- Zero Vitamin Water
- Any other liquid that can be seen through
AVOID any liquids with red or purple dye in them and
do not consume anything after midnight the night before surgery!
Weight Loss Tip:
During the clear liquid diet phase you may need
to consume some sugar containing liquids such as
juice, sweet tea and regular Kool-Aid to keep your
sugar level from getting too low. However, long term
(≥ 5 months after sugery) you will need to limit
liquid calories such as these as they do not fill you
up and they are quickly converted to fat in the body.
Please remember that long term you need to eat
your calories and not drink your calories, but in
the first six months after your surgery it is okay to
drink liquid protein drinks as part of your diet.
Patient Education Handbook 12
• Tuna, salmon or canned chicken in water (no oil)
• Creamed soups
• Soups that may be blended
• Blender (if presently do not have one)
• Journal or notebook
• Don’t forget your vitamin/mineral supplements!!!
Hospital Pre-Admitting Procedure
Before you can have your surgery, you will follow your hospital’s and surgeon's policy on pre-operative testing.
Pre-Surgery Grocery List
Stock up on Healthy Foods/Beverages
Before Surgery
Immediately after surgery you will not feel like going to
the store to find something that you can drink/eat. So, we
encourage you to stock up on the following grocery items
before your surgery so that healthy/high protein foods/
beverages will be available when and where they are needed.
• Protein Powder/supplement
• Meal Replacement Shake such as Bariatric Advantage™
Meal Replacement, Myoplex Light, EAS Advantage
• Crystal Light® or Sugar-free Kool-Aid®
• Sugar-free Popscicles
• Skim milk, 1% milk, light soy milk, powdered milk
• Hot cereals (no sugar added) - LAP-BAND®. Wait two
weeks before trying
Based on your surgeon’s orders, a series of tests will be
performed to make sure that your body is ready and that it
is safe to do surgery. You will hear the term “pre-op testing”
frequently during this process. These tests can include
drawing blood, X-rays, ultra-sounds, echocardiograms,
heart stress tests and any other tests that your surgeon or
other specialists deem necessary for your safety. All of these
tests are ordered based on your age, sex, and weight and
associated medical conditions you have. These tests may be
done 1 to 4 weeks prior to your surgery. Some tests may be
done at your doctor’s office. Testing can take one or two days
prior to surgery. The results of these tests will determine if
you are ready for surgery or need more tests, or need to be
evaluated by a different specialist. Your doctor or surgeon
will make this decision based on the results of the different
tests. Specific instructions will be given to you by your
hospital or surgeon’s office.
What To Bring To The Hospital • Cottage cheese (small curd)
It is recommended to bring only the bare necessities to the
hospital. Do not bring any jewelry or more than $20 cash.
• Canned fruits except pineapple (canned in fruit juice/
water only)
There are a few other things that may make your stay a little
more comfortable:
• Eggs, egg whites in carton, or egg substitutes
• Canned beans or refried beans or mashed potatoes
(flakes would be easier)
• Cheese (low fat or skim, no jalapeño cheese or other
cheese with big chunks that would be hard to digest
during full liquid/pureed stage)
• Th
is handbook
• Lip moisturizer
• S mall overnight bag with toiletries such as toothbrush and
toothpaste, soap, shampoo and lotion
• Baby food (no sugar added)
•B
athrobe
• Yogurt (made with artificial sweetener and no chunks of
fruit), sugar-free custard, pudding, or high protein sugarfree pudding
•C
omfortable, loose-fitting clothes to go home. Clothes that
are easily removed and easy to slip on are best.
Patient Education Handbook 13
Y our S urgery D ay
Personal Preparation
We recommend that you shower in the morning on the day
of surgery, but do not use any moisturizers, creams, lotions,
or make-up. Remove your jewelry and do not wear nail
polish. You may wear dentures, but you will need to remove
them just prior to surgery. Please bring your eye glasses and
a case if possible.
General Surgical Risks
BLOOD CLOTS IN THE LEGS OR LUNGS: Patients who
are having surgery are at risk for blood clots forming in the
veins of their legs. These blood clots are dangerous because
they can travel to the lungs. While blood clots in the legs
are not fatal, they can leave the legs and travel to the lungs
which could result in death. A leg vein blood clot is called
Deep Venous Thrombosis (DVT). A blood clot that leaves
the leg veins and travels to the lungs is called a Pulmonary
Embolism (PE).
The best way to avoid blood clots in the legs or lungs is to
get up and get walking as soon as you can after surgery.
Your surgeon, doctor and the hospital recognize the risk of
DVT & PE to the weight loss surgery patient. Because of this
they take great precautions to avoid this serious problem.
During surgery you will have boots placed on your legs that
will squeeze your legs to keep the blood in your legs moving
to avoid clots. You will wear these sleeves in the hospital
while you are in bed or in a chair. They can come off for
walking and bathing. Your doctor may also prescribe injections of blood thinners while you are in the hospital to avoid
clots in you legs and lungs, but usually only with personal
history of clotting. *Birth control and hormone replacement therapy increases the risk of post-op clotting. Discuss
alternatives with your primary care physician.
Some patients are at such a high risk for developing DVT or
PE that the surgeon may request the patient go home with
a prescription for blood thinner injections. Some patients
may need a special filter (IVC filter) placed inside their
body before their weight loss surgery. This filter is like an
umbrella, placed in a very large vein in the body, located
in the very back of the belly (Inferior Vena Cava, IVC).
This filter is placed with small wires and catheters, using
the veins in the groin or neck to place the filter. Not every
patient needs this. Today’s modern filters are removable
and can be removed the same way they are inserted. Your
Patient Education Handbook 14
surgeon will make this decision with you. These filters can
save a person’s life.
It is important for you to understand fully the risks involved
with surgery so that you can make an informed decision.
Although surgical complications are infrequent, all surgeries
have some degree of risk. Your surgical team will use
their expertise and knowledge to avoid complications. If a
problem does occur, your surgical team will use those same
skills in an attempt to solve the problem quickly. The importance of having a highly qualified medical team and the use
of a certified facility cannot be overestimated.
In general, the least serious problems occur more often and
the more serious problems occur rarely. If a complication
does arise, you, the surgeon, and the bariatric nursing staff
will work together in order to resolve the problem. Some
complications can involve an extended hospital stay and
recovery period.
Anesthesia
When general anesthesia is used, you will be sound asleep
and under the care of your anesthesia provider throughout
the operation. Once you are settled on the operating table,
you will be connected to several monitors and an intravenous (IV) catheter. A quick acting sedative will be given
through the IV tubing after you have breathed oxygen for a
few minutes. Once you fall asleep, your anesthesia provider
will usually slip an endotracheal tube through your mouth
into your windpipe to guarantee that your breathing is
unimpeded. An anesthetic gas and other medications will
keep you asleep and pain free.
Many patients have an instinctive fear of anesthesia.
Extremely sensitive monitors used during surgery have
greatly reduced the risks of anesthesia. A minute change
in the oxygen level in your blood, in the amount of carbon
dioxide you breathe out, in the percentage of anesthetic gas
being administered, in your heart rate, or in your blood
pressure would be reported immediately. The sophisticated
monitoring system now used makes recognition and treatment of problems with anesthesia almost immediate.
Your anesthesia provider will discuss the specific risks of
general anesthesia with you before your surgery.
Hospital Admitting Procedures
Check-in at the hospital. You will be asked to change your
clothing and put on a hospital gown. If you wear dentures,
corrective lenses, or hearing aids you will be asked to
remove them for safety reasons.
You will be asked to sign an operative consent form, even
though you may already have done so at your surgeon’s
office. Your signature indicates that the procedure has been
explained to you, that you understand it, and that you have
no further questions.
Your blood pressure, pulse, respiration, oxygen saturation, temperature, height and weight will be measured. An
intravenous (IV) line will be placed. This allows fluids and/
or medications into your blood stream.
The Operating Room
Going to the Operating Room (OR) is not a normal
experience for most of us. Your surgical team recognizes the
natural anxiety with which most patients approach this step
in the process to achieving their goals. Specialists using the
most modern equipment and techniques will attend to you.
Once you enter the OR, the staff will do everything they
can to make you feel secure. There, the nurses who will be
assisting your surgeon will review your chart. Medicines
that will make you drowsy will flow through the tubing into
a vein. You will be connected to monitoring devices. Your
surgical team will take excellent care of you! When your
surgery has been completed and your dressings are in place,
you will be moved to the Recovery Room.
The Recovery Room
You will be closely monitored during this period. When
your initial recovery is completed and all your vital signs are
stable, you will be transported to your room or discharged
home according on you and the procedure you choose.
Most patients have very little memory about their stay in the
Recovery Room. If you are going home from the Recovery
Room your family/friend will be given instructions for you
to follow.
Y our H ospital S tay
Recovery
The hospital stay for Bariatric Surgery averages from same
day discharge to two days, longer for those with complicated
medical conditions. Patients undergoing the laparoscopic
method usually have a shorter hospitalization. When you
return to your room after surgery, you will continue to be
closely monitored by your nurses.
Along with periodic monitoring of your vital signs (blood
pressure, pulse, temperature, respirations), your bariatric
nurses will encourage and assist you in performing deep
breathing, coughing, leg movement exercises, and getting
out of bed after surgery. All of these activities prevent
complications. Be certain to report any symptoms of
nausea, anxiety, muscle spasms, increased pain or shortness
of breath to your bariatric nurse. To varying degrees, it is
normal to experience fatigue, nausea and vomiting, sleeplessness, surgical pain, weakness and light headedness, loss
of appetite, gas pain, gas, loose stools, and emotional ups
and downs in the early days and weeks after surgery. You
may discuss specific medical concerns with your surgeon.
With the instruction of your bariatric nurse and/or
Physical Therapist, you should sit up and dangle your feet
and stand at your bedside. Yes, it will hurt, but each time
you get out of bed it will get easier. You will be asked to
get out of bed and walk as soon as possible. You will be
required to walk at least every one to two hours during
waking hours, and to do your breathing exercises hourly.
Changing positions in bed, walking and exercise promotes
circulation. Good blood flow discourages the formation
of blood clots and enhances healing. The bariatric floor
nurses will remind you to walk and draw deep breaths.
Getting up, walking and doing your post-operative exercises will speed up your recovery and minimize complications. Each day you will notice your strength returning,
with less and less pain. Remember, if your procedure is
not an overnight stay, that it is imperative that you get up
and move.
Exercises that Speed Your Recovery
To enhance you recovery your bariatric nurse will instruct
you in coughing and deep breathing, turning in bed and
exercising your feet and legs. You will be shown how to use
an “incentive spirometer” to help you expand your lungs.
Coughing and deep breathing is important so that you will
Patient Education Handbook 15
loosen any secretions that may be in your throat or lungs and
to help prevent pneumonia. Deep breathing also increases
circulation and promotes elimination of anesthesia.
The proper way to deep breathe and cough is to follow
these steps:
nurses and doctors will ask you to pick a way that you can
describe your pain. This is done to ensure uniform language.
One helpful way to describe pain include the number scale
(0 to 10 scale: 0 = no pain, 10 = the worst pain possible) or
you can use words (none, mild, moderate, severe).
2. Hold breath for two seconds
No matter which form of pain control you receive — PCA
or pill — here are some pointers to help you be more
comfortable:
3. Exhale completely
1. Tell your nurses and physician if you are having pain,
1. Inhale as deeply as you can
4. Repeat the above steps three times
5. Inhale deeply
6. Cough. The cough should come from the abdomen, not
from your throat. Hold your pillow on your abdomen for
support. Exercising your feet and legs is important for
promoting good circulation.
The proper way to exercise your feet and legs is to follow
these steps:
1. Push your toes of both feet towards the end of the bed
(as in pressing down on a gas pedal).
2. Pull your toes toward the head of your bed, then relax.
3. Circle each ankle to the right, then to the left.
4. Repeat three times. These exercises should be repeated at
least once every hour after surgery, but it is also a good
idea to practice these exercises before surgery to increase
lung function and agility.
Pain Control
You may feel pain where the incision was made or from the
position your body was in during surgery. Some patients
may experience neck and shoulder pain after laparoscopy.
Your comfort is very important to your medical team.
Although there will always be some discomfort after an
operation, keeping your pain under control is necessary for
your recovery. When you are comfortable you are better able
to take part in activities such as walking, deep breathing and
coughing. These activities are imperative in order to recover
more quickly.
If you are feeling pain after surgery, you will be able to
push a button on a cord to administer pain medication to
yourself. This method of administration is called “patientcontrolled analgesia” (PCA). As soon as you are able
to tolerate fluids, your medical team will add oral pain
medication.
Pain Control: Please remember that you will not be
bothering the staff if you are asking for pain medicine! Your
Patient Education Handbook 16
particularly if it keeps you from moving, taking deep
breaths, and generally feeling comfortable.
2. Everyone is different, so keeping your nurses informed
about how you feel will help them help you.
3. Plan ahead for pain; if you are comfortable lying down,
you may still need pain medication to get up and walk
around.
4. Keep ahead of the pain. Don’t wait for the pain to be at
its worst before you push the PCA button or ask for pain
medicine. Pain medication works best when used to prevent pain.
5. The risk of becoming addicted to pain medicine is very
low when it is used for a specific medical purpose, such
as surgery.
Diet at the Hospital
At the hospital, you will be served clear liquids as your new
stomach pouch begins to heal. If you are served something
other than clear liquids, or if you receive sugar or carbonated beverages on your tray then do not consume it. The
kitchen may have made a mistake. Call your bariatric floor
nurse to have your meal changed. It is a very unlikely occurrence to have the wrong meal served; however, in light of
your post-op status, we thought that it would be worth
mentioning.
H ome A gain
Checking In
If you are a LAP-BAND® patient then you will most likely
be discharged home on the day of surgery (unless your
insurance plan/medical condition dictates that you stay
overnight). You will be discharged on clear liquids. When
you are discharged, continue on clear liquids as tolerated.
If you are a Gastric Sleeve/Gastric Bypass patient
then you will typically stay at least 1-2 nights in the hospital.
The day of surgery you are not to consume anything by
mouth. The morning after surgery you will be sent to
X-ray for a swallow study. If everything looks good then
the Surgeon will start you on a Bariatric Clear Liquid Diet.
When you are discharged your Surgeon wants you to remain
on a Clear Liquid Diet for 1 week.
Most likely, you will not feel hungry the first week or so after
surgery. This is normal, no reason for concern and may last
a few weeks. However, it is very important to keep drinking
water and to consume your protein drinks when at home to
help prevent dehydration and to promote healing.
Going Home
Your date of discharge will be determined by your surgeon
based on your individual progress. Prior to your discharge,
specific dietary and activity instructions will be reviewed
with you, along with precautions and situations when
your surgeon should be notified. Discuss your going home
concerns with your nurse or discharge coordinator.
Please give some thought to your living environment. Are
there many steps in your home? Is your bedroom upstairs?
How accessible is your bathroom? Please tell the hospital
staff about your living environment so they can prepare your
going home with your specific needs in mind.
You will be seen by your surgeon one week postoperatively. A doctor or nurse practitioner will see you for
all follow-up appointmens. If you are a gastric sleeve or
bypass patient you will be seen at 3 months, 6 months, 9
months, 12 months, and 18 months post-operatively, then
annually thereafter. If you are a Lap-Band patient, you will
be seen monthly for the first six months, then yearly, and as
needed between scheduled visits. Please call your surgeon’s
office with any surgical concerns between scheduled visits.
We would also ask that you keep in mind that in order for
our program to maintain our Center of Excellence rating,
and provide others with this same surgical opportunity,
you must commit to keeping your follow-up appointments.
However, we urge you to keep your Primary Care Physician
in the loop by contacting him or her with other medical
concerns and/or medication adjustments between your
regularly scheduled visits.
Specific Recovery Instructions
There are many things you will experience once you are home
recovering. Your activity will be restricted to no strenuous
activity for 4 weeks after the operation. You are to walk and
may perform light household duties as tolerated upon your
return home. Frequent walks of short duration (such as 5 to
10 minutes) are tolerated better than one or two long walks
that go to or past the point of fatigue. Increase the distance
that you walk at week two post surgery. By four weeks after
surgery you should be walking for at least 30 minutes unless
you have specific disabilities. In that case, water exercises are
recommended. You can start water activities about 3 to 4 weeks
after surgery. Patients undergoing the laparoscopic method
are more frequently able to return to all activities within a
shorter time frame. You may be tired, weak, and/or nauseated
the first few weeks after surgery. Keep up your fluid intake
with small, frequent sips as necessary 48 to 64 oz. a day is the
recommended minimum intake. Refer to the Diet section for
specific dietary instructions. Resume traveling short distances
as soon as you feel strong enough to make the trip. Do not
drive a motor vehicle until you are off the prescription pain
medicines, usually about one week after your surgery.
The first several weeks after your surgery you may feel weak
and tire easily after activity. However, try to be as active as
possible. Plan to walk as much as you can tolerate without
becoming too tired. Start with short walks, increasing the
distance each day. The more physically active you are, the
more recovery is enhanced and the more energy you’ll
Patient Education Handbook 17
have. Continue walking at least five times daily, so that you
are walking 30 to 45 minutes by the sixth week. Find out
more about starting an exercise program by reading the
Exercise Section.
Avoid sitting and standing without moving for long periods.
Change positions frequently while sitting, and walk around
in lieu of standing still. These strategies will help prevent
blood clots from forming in your legs.
Personal Hygiene
Most patients like to have someone home with them the
first few days after surgery for moral and physical support.
Due to the nature of abdominal surgery, you may need
some help with toileting. Flushable baby wipes tend to be
gentler for personal hygiene, as well as a peri-bottle and/or
use a small sports-top water bottle. A long sponge stick can
be very helpful.
Bandages & Wound Care
Your wound needs minimal care. If sutures were used, they
dissolve, so there is no need to remove any stitches. You may
notice some tape on your wound. This tape is called “SteriStrips.®” They will fall off on their own. If surgical staples
were used, they will have to be removed, usually around
your tenth post-op day. The removal of surgical staples is
painless. Leaving the wound open to air, whenever possible,
helps prevent suture infection.
No matter how your wound was closed, it is important to
keep the wound clean and dry to promote faster healing.
You may shower, but pat dry the incision area. After about
three weeks, the incision is usually ready for submersion.
Ask your surgeon for the official “go ahead” at your follow
up appointment before you take a bath. As you feel stronger
you may enjoy a swim or a soak in the tub. Despite the
greatest care, any wound can become infected. If your
wound becomes reddened, swollen, leaks pus or has red
streaks, has yellow/green purulent and/or odorous drainage,
feels increasingly sore or you have a fever above 100.5°,
you must report to your surgeon right away. Please do not
use any antibiotic ointment, peroxide, or other occlusive
ointment on your incision. The bottom line: (unless
otherwise prescribed) shower, wash with soap, rinse and dry
thoroughly. If wound is oozing or catching on clothing you
may cover with a very light dressing, otherwise leave open
to air.
Drainage from surgical wounds is not unusual. A clear or
pale yellow drainage is not unusual after surgery. Anything
other than this should be reported to your surgeon. Bloody
drainage or thick cloudy (pus) drainage should be reported
to your surgeon.
Patient Education Handbook 18
Caring for Incisions
Remove the bandage 3 days after surgery if it is still on.
Leave the Steri-Strips® [strips of tape over the incision] in
place if you have them; they will curl and fall off. If they are
still in place 2 weeks after your surgery, gently peel them
off. You can do this in the shower. The incision (cut) may
itch during healing; this is normal. Do not scratch the area.
Sutures were utilized which will dissolve on their own,
there is no need to have them removed. A small amount of
redness at the edges of the incision sites, as well as a small
amount of clear or bloody leakage from the wound, is
acceptable. Any drainage that is cloudy white or has a foul
smell should be reported to the surgeon immediately.
Pills and Medications
Your doctor / surgeon may write prescriptions that are
important for your recovery after surgery. Take all of your
medications as instructed. Ask questions if you do not
understand how to take a medicine or what it is for. Make
sure you have enough medicine to last through your hospitalization and recovery. DON’T WAIT UNTIL YOU ARE
IN THE HOSPITAL TO ASK FOR A NEW MEDICINE OR
REFILL. Have your medicines ready and waiting for you at
home. After Weight Loss Surgery you should not take
more than 2 or three 3 pills at the same time. This
will avoid blocking your pouch and will avoid nausea or
vomiting. It is strongly recommended that you do not
take medications on an empty stomach. After weight loss
surgery your stomach will be shaped like a funnel. If you
put a bunch of pills (think marbles) in a funnel it will get
stopped up which could result in vomiting. Post-op pain
medication can be cut in half, quartered or crushed. As
soon as your pain no longer warrants the narcotic medication, it is okay to convert to Tylenol. This will help prevent
constipation related to the use of narcotic pain medication.
Medications to Avoid
Do not use the following medications unless instructed by
your physician or surgeon; as they may cause ulcers in your
stomach pouch:
• Advil
• Aspirin
• BC Powder
• Pepto Bismol
• Excedrin
• Motrin
• Aleve
• Ibuprofen
• If you take
Plavix avoid
proton pump inhibitors (Prilosec, Nexium, Protonix)
Please ask your doctor for an alternative.
Driving
You will not be able to drive a car 24 hours after your
surgery, and as long as you are taking narcotic pain
medication. If your surgery is an outpatient surgery you
can leave the hospital in your family car that day with a
driver. You must have someone drive you home the day of
surgery. DO NOT DRIVE ANY VEHICLE OR OPERATE
ANY MACHINERY WHILE UNDER THE INFLUENCE OF
NARCOTIC PAIN MEDICATION.
Vitamins/Minerals
All weight loss surgery patients are at increased risk
for nutrition deficiencies. However, any nutrient
deficiencies can be easily prevented by supplementing with
recommended vitamins/minerals on a daily basis. Which
vitamins/minerals are recommended for you depends
on which surgery you are having. Our vitamin/mineral
recommendations are seen on the next page.
Patient Education Handbook 19
Vitamin and Mineral Recommendations
Here is a list of required vitamins and minerals after surgery. Taking the following vitamins after bariatric surgery is
essential since you will not be receiving the recommended amount from food alone. You will only be able to eat small
amounts, so it is very important that you still get your vitamins and minerals from supplements so you do not become
malnourished. Vitamins should be liquid, chewable or small capsules.
Surgery
Vitamin and Mineral Requirements
Lap-Band
• Multivitamin
• 1200mg of calcium daily
• 1 B-complex daily x 6 months after surgery
• 5,000 units of vitamin D3 daily or 10,000 units
every other day
Gastric Sleeve
• Multivitamin
• 1200mg of calcium citrate daily
• 1 B-complex daily x 6 months after surgery
• 1 sublingual B-12 tablet dissolved under tongue daily
• 18mg of iron if not included in your multivitamin
Take any iron 2 hours before or after calcium
• 5,000 units of vitamin D3 daily or 10,000 units
every other day
Gastric Bypass
• Multivitamin
• 1200mg of calcium citrate daily
• 1 B-complex daily x 6 months after surgery
• 1 sublingual B-12 tablet dissolved under tongue daily
• 18mg of iron if not included in your multivitamin
Take any iron 2 hours before or after calcium
• 5,000 units of vitamin D3 daily or 10,000 units
every other day
Patient Education Handbook 20
Vitamin and Mineral Brand Recommendations
Supplement
Best Choice
Better Choice
Good Choice
Multivitamin/Mineral
Bariatric Advantage
or Celebrate
(in office or online)
Optisource
(available at
Walgreens)
Centrum Chewable
(available at most
stores)
Calcium
Calcet Chewy Bites
or Bariatric
Advantage Calcium
Citrate
(in office or online)
Opurity Calcium
Citrate Plus
(online at www.
opurity.com)
Citrical Petites +D3
(available at
Walgreens)
B-complex
Bariatric Advantage
B-50 Complex
(in office or online)
Rainbow Light
Energy B Complex
(available at
Walgreens & Target)
Nature Made Super
B Complex
(available at most
stores)
B-12
Bariatric Advantage
Sublingual B12 with
Folic Acid
(in office or online)
Spring Valley
Sublingual B12
(available at
WalMart)
Nature Made Oral
B12 tablets
(available at most
stores)
Iron
Bariatric Advantage
Iron 29 mg with
Vitamin C
(in office or online)
Bifera Dual Action
Iron
(available at
Walgreens, CVS
and Kroger)
Walgreens Ferrous
Sulfate 325mg Iron
Vitamin D
Bariatric Advantage
Vitamin D3 10,000
units
(only take 1 every
other day)
Bariatric Advantage
Vitamin D3
5,000 units
(1 daily)
Nature Made
Vitamin D3
5,000 units)
(available at
Walgreens, CVS
and Kroger)
** DO NOT mix calcium with iron containing supplements.
Take Calcium at least 2 hours before or after iron**
**Bariatric Advantage products can be purchased in office or online
at www.MyBariatricSolutions.com**
Patient Education Handbook 21
Starter Kit Recommendations
We recommend Bariatric Advantage products because they are specifically designed to meet the nutritional
requirements of bariatric surgery patients. These products can be purchased in our office or from our E-Supplement
Store on our website. It is highly recommened that you take a multivitamin as soon as possible after your initial consult
in preparation for surgery.
Recommended 1 week before surgery
• BA Multivitamin capsules or BA Vitaband Complete Chewable Multivitamins
• BA High Protein Meal Replacement Shakes
• Quest Protein Bars
Required after surgery
Lapband
• Multivitamin
• Calcium
• B-Complex
• Vitamin D
Gastric Sleve & Gastric Bypass
• Multivitamin
• Calcium Citrate
• B-Complex
• Vitamin D
• Sublingual B-12
• Iron (if not in multivitamin)
Highly recommended after surgery
Lapband
• Bariatric Advantage VitaBand
Complete Chewable Multivitamin
or
Bariatric Advantage Multivitamin
Capsule
• Bariatric Advantage Calcium Citrate
• Bariatric Advantage B-50 Complex
• Bariatric Advantage Dry Vitamin D
Gastric Sleeve & Gastric Bypass
• Bariatric Advantage VitaBand Complete
Chewable Multivitamin
or
Bariatric Advantage Multivitamin Capsule
• Bariatric Advantage Calcium Citrate
• Bariatric Advantage B-50 Complex
• Bariatric Advantage Dry Vitamin D
• Bariatric Advantage Sublingual B-12
• Bariatric Advantage Chewable Iron
Patient Protein Supplement Favorites
• Nectar - Strawberry Kiwi, Fuzzy Navel, or Twisted Cherry
• BA Protein Meal Replacement - Chocolate and Banana
• Quest Bars - Chocolate Brownie, Coconut Cashew, Cinnamon Roll
Doctor Favorites
• Nectar - Strawberry Kiwi, Fuzzy Navel, or Twisted Cherry
Patient Education Handbook 22
All weight loss surgery patients need to schedule a
visit with their surgeon anually after surgery to have
all of their vitamin/mineral labs reviewed. It is a life
or death proposition.
M edical C oncerns
Urgent Symptoms
Infection:
Watch for signs and symptoms of infection. These can be
a rapid pulse rate over 120 beats per minute that does not
slow down, a fever greater than 101° orally, chills and/or
increased redness or pus draining from the incision sites.
Look for increasing abdominal pain, nausea, vomiting or
shortness of breath. If you experience any of these please
call your surgeon immediately or go to the Emergency
Room; if you are unable to do either call 911.
usually within 2 to 3 months as the nerve endings heal
spontaneously.
4. Itching – itching and occasional small shooting
electrical sensations within the skin frequently occur as
the nerve endings heal. These symptoms are common
during the recovery period. Ice, skin moisturizers,
Vitamin E oil and massage are often helpful (no topicals
the first 30 days post-op).
5. Redness of scars – all new scars are red, dark pink
or purple. The scars take about a year to fade. We
recommend that you protect your scars from the sun for
a year after your surgery. Even through a bathing suit,
a good deal of sunlight can reach the skin and cause
damage. Wear a sunscreen with a skin-protection factor
(SPF) of at least 15 when out in sunny weather.
Home Pharmacy Supplies
• Gauze pads
Even though we do not expect you to have any serious
problems, some symptoms that you may experience need
to be addressed immediately. If you experience any of these
symptoms, contact your surgeon right away:
• Bandage tape
1. Fever (101° F. or above).
Nausea
2. Redness, swelling, increased pain and/or pus-like
Nausea is common for the first several days to first few
weeks after surgery.
drainage from your wound.
3. Chest pain and/or shortness of breath/ heart-rate
over 120.
4. Nausea and/or vomiting that last more than 12 hours.
5 Pain, redness, and/or swelling in your legs.
6. Urine output less than four times in 24 hours.
7. Pain that is unrelieved by pain medication.
Normal Symptoms
1. Swelling and bruising – moderate swelling and bruising
are normal after any surgery. Severe swelling and
bruising may indicate bleeding or possible infection.
2. Discomfort and pain – mild to moderate discomfort
or pain is normal after any surgery. If the pain becomes
severe and is not relieved by pain medication, please
contact your surgeon.
3. Numbness – small sensory nerves to the skin surface
are occasionally cut when the incision is made or
interrupted by undermining of the skin during surgery.
The sensation in those areas gradually returns –
• Thermometer
• Acetaminophen
Main Reasons For Nausea
1. OVERLOADING YOUR POUCH
2. NOT EATING ENOUGH PROTEIN
3. NOT DRINKING ENOUGH FLUIDS
4. NOT EATING OFTEN ENOUGH
5. EATING TOO FAST
Be careful. Pay close attention to these things so that you
do not become sick unnecessarily
Nausea may be related to insufficient chewing, fullness,
sensitivity to odors, pain medication, not eating, postnasal
drip and/or dehydration. For nausea that occurs in the
first days after surgery, the nausea can be suppressed with
anti-nausea medications. In unusual cases the nausea
can be so severe that it prevents patients from taking in
adequate amounts of liquids. If this happens you need to
come back to the hospital to receive intravenous fluids.
Persistent vomiting can lead to dehydration and electrolyte
imbalance, and can cause vitamin deficiencies to occur.
Patient Education Handbook 23
• Learn to recognize when you are full. This will not
happen immediately, but by eating very slowly, it will
become easier.
• Should you have difficulty drinking due to nausea, you
may want to try peppermint tea, fennel tea, decaffeinated
green tea or water with lemon (hot or cold).
• If you believe that your pain medication is the cause of
your nausea, please call your surgeon’s office to have the
prescription changed.
• Stay hydrated – fluids should be continuously sipped all
day long to prevent dehydration. You need a minimum
of 48 to 64 oz. of fluids per day. Increase this amount by
20% if you are sweating.
• Take your nausea medicine as prescribed by your
surgeon.
Vomiting
If you are vomiting every time you drink fluid or your
protein drink in any 24-hour period call your surgeon’s
office immediately. If this does not appear to be a dietary
issue once our office has spoken to you, it may be an
indication that certain diagnostic radiology or other
testing must be performed to determine the cause of the
problem.
Vomiting is often associated with eating inappropriately.
It is very difficult to gauge in the beginning how little food
will satisfy your hunger. Chew your food well, keep it moist
and eat only half of what you anticipate eating. If there is
still space, and you still feel hungry, then you can always eat
more. Chances are that you are going to feel full with very
little. A couple of teaspoons may be all that you can take in
at one time.
If you overeat after surgery, you may vomit. Sometimes
fullness occurs quickly. Allow yourself time to recognize
the feeling of fullness. Typically, with Gastric Bypass, a
profound feeling of satisfaction follows the fullness within
a few minutes, and makes further eating a matter of
indifference.
These may cause vomiting:
• Eating solid foods too soon after surgery
• Drinking liquids either with meals or right after meals
• Lying down after a meal
• Eating foods that do not agree with you.
• If you begin vomiting and it continues throughout the
day, stop eating solid foods and sip clear liquids (clear
and very diluted juice, broth and herbal tea). Should you
have difficulty swallowing foods or keeping foods down,
please call your surgeon. Vomiting may indicate that
the stomach pouch is blocked. If vomiting persists for
more than 24 hours, it can lead to severe dehydration - a
situation that needs to be taken seriously.
Dehydration
First symptom = elevated heart rate, dark urine, and
infrequent urination. Dehydration will occur if you do not
drink enough fluids. Symptoms include fatigue, dizziness,
fainting, nausea, low back pain (a constant dull ache across
the back), and a whitish coating on the tongue. Blood
work should be done if these symptoms persist, in order to
establish the severity of dehydration. Dehydration may lead
to bladder and kidney infections. Contact your surgeon if
you believe that you may be dehydrated. In some cases you
need to be admitted to the hospital so that fluids can be
administered.
Note: If your urine is dark and your mouth is dry, you are
not drinking enough.
This is what you can do in order to prevent dehydration:
• Buy a sports bottle and take it with you everywhere so
you can sip water all day.
• Drink at least 48 to 64 oz. of fluids per day. Increase this
amount if you are sweating.
• Avoid beverages containing caffeine – they are a diuretic
and can dehydrate you. Unsweetened herbal iced tea is
okay to drink.
• If you have difficulties drinking due to nausea, suck on
ice chips.
• Eating too fast
Bowel Habits
• Not chewing food properly
Constipation
• Eating food that is too dry
Constipation is defined as a lack of bowel movement for 3
to 4 days, or the frequent passage of dry/hard stools that
cause excessive straining when you use the bathroom.
• Eating too much food at once
Patient Education Handbook 24
Constipation is a frequent complaint for weight loss
surgery patients. However, constipation can be prevented
and effectively managed if you know the most common
causes and the most effective solutions. The main causes of
constipation in weight loss surgery patients include:
• The use of pain medications during the early
post-op phase. These are discontinued as soon as possible
after surgery and so this is not a long-term contributor to
constipation.
• Not drinking enough water. Adequate fluid
intake will moisten the stool and keep things moving. So,
make sure and consume at least 48 to 64 oz. of fluid/day
• Lack of exercise. Sitting around too much will
cause stool to sit in your colon too long. So, get to
moving.
• Inadequate fiber intake. When you are back to
a regular diet make sure and consume some high fiber
foods in your diet daily such as: beans, oatmeal, fruits
with skins, vegetables, whole grains. This fiber will keep
things moving.
If you experience constipation despite following the above
advice then consider using a stool
softener such as Colace™ on a
regular basis. This will soften the
stool and make it easier to pass. If
you are really constipated then it’s
ok to use a strong over the counter
laxative such as Dulcolax or Milk
of Magnesium to get this flowing;
however, avoid using strong laxatives on a regular basis as they
will cause your colon to become
dependent on them to contract
and this could lead to severe/
permanent constipation that is
difficult to resolve.
After restrictive surgery, the amount of food consumed
is greatly reduced, and the quantity of fiber or roughage
consumed may be much smaller. Correspondingly, the
amount of bowel movements will be diminished, causing
less frequent bowel activity, and sometimes constipation. If
this becomes a problem, a stool softener may be indicated to
avoid rectal difficulties.
Avoid any laxatives that contain Senna and
avoid taking Milk of Magnesia or Magnesium
Citrate on a regular basis. Please remember.
Constipation is not a midnight emergency.
Diarrhea
Diarrhea may occur in all weight loss surgery patients
during the first 1 to 2 weeks after surgery as the liquid
diet during the first 2 weeks post-op tends to pass quickly
through the bowel. This is completely normal and nothing
to be concerned about. Two weeks post surgery you will
transition to a soft diet. At this point bowel movements will
start to become more solid and it will continue to become
more solid as you continue to transition back to a regular
diet.
If you are a gastric bypass patient then you may still
experience occasional diarrhea or have one to three soft/foul
smelling stools for the first few months after surgery. This is
due to the fact that your small intestine has been rerouted
and the food does not have much time to get absorbed
in the small intestine. As a result, some food escapes into
the colon and the bacteria there ferment it and cause loose
stool/gas. After a few months these issues resolve as the small
intestine becomes more efficient at absorbing food and leaves
less food for those bacteria found in the colon to eat. Please call
your surgeon if you have persistent diarrhea.
Gas
As mentioned above, flatulence (excessive gas) is a
complication of weight loss surgery in gastric bypass
patients for the first few months. Flatulence is not a
common side effect of gastric sleeve and LAP-BAND®
surgery, but still may occur in a few individuals who have
had these surgeries. As mentioned, this issue usually
resolves itself on its own in a few months; however, until
then consider the following treatment strategies:
• Eat slowly and chew your food thoroughly (make
your mouth do the work that your intestines use to do).
• Avoid sugar alcohols. Some
sugar-free foods/products such as: Xylitol, Mannitol,
Sorbitol.
• If you are lactose intolerant then avoid diary
(cheese and yogurt should be fine), or take a lactase
digestive enzyme when you consume unfermented dairy
products.
• Try gas-relief meds such as Gas-X, Simethicone, or
Phazyme (all over-the-counter products).
Indigestion
It is not unusual to experience indigestion or heartburn
after the surgery. Medications are prescribed to protect the
intestinal tract and help the intestinal tract move its contents
Patient Education Handbook 25
forward, however, indigestion and heartburn can be experienced after the surgery. These usually disappear when
weight loss begins and usually disappears after 50 lbs. are
lost. If heartburn does come about and the above medications have not helped it is okay to take Maalox, Mylanta,
Tums or Rolaids. If it is necessary to take these medications
for more than 2 weeks, let the doctor know, as a different
prescription may be required. However, heartburn will pass
particularly as you enter a regular habit in your new diet.
Lactose Intolerance
If you are a LAP-BAND,® or Gastric Sleeve patient and don’t
have lactose intolerance before weight loss surgery, then you
should not have it after weight loss surgery. However, if you
have Gastric Bypass then there is a chance that you could
develop intolerance to lactose after your surgery. This is due
to the rerouting of your small intestine. After gastric bypass
surgery, the milk sugar (lactose) does not have much time
to act with the milk digesting enzyme lactase in the small
intestine. As a result, milk sugar escapes into the colon and
is fermented by bacteria that reside there. As a result you
experience cramping, diarrhea, and excessive gas.
If you experience lactose intolerance after weight loss
surgery then it can be easily managed by implementing the
following recommendations:
• Avoid unfermented dairy products such as milk and ice
cream, or foods high in milk.
• Consume dairy products that have been fermented first
such as yogurt and cheese. The bacteria in these products
have broken down the milk sugar for you so that your
intestine doesn’t have to.
• If drinking milk, choose Lactaid™ milk which has the
milk sugars predigested.
• Take a Lactase Digestive Enzyme (sold over the counter)
with any milk or ice cream products.
Drainage
Your incision will usually have drainage. It will start
anywhere from 4 to 5 days after surgery and may continue
for 2 to 3 weeks. THIS IS NORMAL. Keep the area clean
and dry. Cover with an abdominal dressing, a sanitary
napkin taped in place, or several gauze 4X4s if the drainage
is not profuse. If you are concerned about the amount of
drainage call the office. If you have drainage that has an
odor, is profuse or white and cloudy with pus or you develop
any other signs or symptoms of infection please call the
office.
Patient Education Handbook 26
Hernias
You may notice a bulge under the skin of your abdomen.
What you are seeing are the bowels that are not being
contained in the abdomen due to a weakness in the
abdominal wall at the site of the incision. You may feel
pain when you lift a heavy object, cough, or strain during
urination or during bowel movements. The pain may be
sharp and immediate. In some cases the pain may be a
dull ache that gets worse toward the end of the day or after
standing for a long period of time. Minimize the risk of
developing a hernia by avoiding heavy lifting for up to three
months after surgery if directed by your surgeon. If you
think that you may have a hernia, please call your surgeon
for a consultation. Surgery is the only way to fix a hernia. If
the hernia comes out and will not go back in when you lie
down and is associated with severe pain and vomiting, it can
result in an emergency. Call your surgeon’s office or your
primary care physician on an emergency basis.
Thrush/Yeast Infections
If you experience sinus problems, colds, gynecological
problems and other illnesses that are definitely not surgery
related please see your primary care physician or specialist
that you were seeing before surgery to have these problems
treated.
You may notice that after surgery you have a white, cottage
cheese-like coating on your tongue. The tongue could also
be very red and inflamed. Most likely you have thrush –
a yeast overgrowth in your mouth. Oftentimes this is due
to large amounts of antibiotics peri-operatively. Call your
primary care physician if you should have an oral infection
or a rash on your skin. You can reduce this problem
by taking Lactobacillus acidophilus in addition to the
prescribed regimen post-operatively.
Vaginal yeast infections are caused by yeast called Candida
albicans. Yeast are tiny organisms that normally live in
small numbers on the skin and inside the vagina. The
acidic environment of the vagina helps keep yeast from
growing. If the vagina becomes less acidic, too many yeast
can grow and cause a vaginal infection. Yeast infections
can be very uncomfortable, but are usually not serious.
Symptoms include itching and burning of the vagina and
around the outside of the vagina (vulva), a white vaginal
discharge that may look like cottage cheese, and swelling.
Yeast infections are so common that most women will have
one some time in their lives. Half of all women have more
than one yeast infection in their lives. If you have symptoms
of a yeast infection, call your primary care physician or
your gynecologist. You can help prevent yeast infections
by not wearing tight-fitting or synthetic clothing, wearing
cotton underwear, not wearing pantihose every day and not
douching or using feminine hygiene sprays. You can also
take Lactobacillus acidophilus in addition to the prescribed
regimen postoperatively.
Anemia
Anemia in weight loss surgery patients can be caused folic
acid, iron and B-12 deficiencies in weight loss surgery
patients. If you are a gastric bypass patient then you will
need to take an iron tablet, a sublingual (dissolved under
tongue) B-12 tablet and a B-complex daily to prevent
anemia. If you are a Gastric Sleeve patient then you need
to take a B-12 tablet and a B-complex (for the first 6
months at least after surgery) daily to prevent anemia. If
you are a LAP-BAND® patient then you only need to take a
B-complex capsule daily for the first 3 months after surgery
to prevent anemia.
note: If you are a LAP-BAND®/gastric sleeve patient then
you don’t need to take additional iron (except for the iron
in your multivitamin) unless instructed to do so.
Transient Hair Loss/Skin Changes
Hair thinning or loss is expected after rapid weight loss.
It is temporary. Unfortunately, that does not make it any
less disheartening. During the phase of rapid weight loss,
calorie intake is much less than the body needs, and protein
intake is marginal. The body is in a state of starvation. One
of the side-effects is hair thinning or hair loss. This is a
transient effect and resolves itself when nutrition and weight
stabilize. The hair loss usually occurs anywhere from 3 to 9
months after surgery. For the same reason, skin texture and
appearance may change. It is not uncommon for patients
to develop acne or dry skin after surgery. Protein, vitamins
and water intake are also important for healthy skin. You
can minimize the loss of hair by taking your multivitamins
daily and making sure that you consume at least 80 grams of
protein per day. We advise patients to avoid hair treatments
and permanents – no need to stress your hair from the
outside, too.
Here are some reasons why one may lose hair following
weight loss surgery:
1. Fast weight loss: Typically stops after loss levels out.
2. Protein Deficiencey/Muscle Loss: Especially patients
eating less than recommended amounts of protein.
3. Lack of Omega 3 in diet: Take at least two fish oil tablets
daily (2000 mg).
4. Lack of Biotin: Try taking Biotin tablets (5 mg or
5000mcg) daily.
Scars
Scars are expected after any surgery. The size of the scars
depend on the type of procedure, the sutures used and how
your body heals. Scars are a fact of life. But there is a way to
make them less visible, should this be a concern of yours.
Once your incision is fully healed, you may start using
silicone pads and scar minimizing creams to make the scars
look softer, smoother, flatter and closer to your skin’s natural
color. Keep your scars out of the sunlight to help them heal
properly.
Sexuality/Pregnancy
You may resume sexual activity when you feel physically and
emotionally stable. Women need to use a mechanical form
of birth control, as fertility may be increased with weight
loss and oral contraceptives may not be fully absorbed.
Pregnancy Guidelines after weight loss surgery procedures
Your surgeon recommends that you do not get pregnant
for at least one year after undergoing a weight loss procedure. You will lose the momentum of the fast rate of weight
loss that you may obtain with the surgery during the first
eighteen months when weight loss is fastest. Also, it will
allow time for you to become healthy and to get your new
lifestyle in place before a pregnancy and the added responsibility of child rearing. Please use some form of protection
against pregnancy for this period of time. You should use
more than one type of contraception to assure that you do
not become pregnant for at least one year. If you want to
have a child now it would be best to postpone the procedure
until after the child’s birth, your recovery and becoming
accustomed to your new parenting lifestyle. Patients do have
healthy pregnancies and healthy babies!
If you do become pregnant the following guidelines are
suggested:
See your OB/GYN as soon as possible.
Baseline labs: Albumin, Pre-Albumin, Folate, B-12, CMP
and CBC need to be performed now, then every 3 months.
Correct any deficiencies.
Vitamins: add prenatal vitamins in addition to regular
vitamins already taken. Vitamins need to be high potency;
Patient Education Handbook 27
B-12 (sublingual or injections) and iron should be ferrous
fumerate at 324 mg and should be taken daily. Do not take
iron with cereals, cheese, coffee, eggs, milk, tea, whole grain
breads or yogurt. Taking iron with these foods can impair
absorption, however, taking iron with a food rich in vitamin C
aids iron absorption. Separate calcium and iron with a 2
hour interval between.
Blood sugar: Ask your Obstetrician to obtain a fasting
glucose level and a 2-hour post-prandial glucose level and
an HgbAlc rather than a GTT.
Exercise: Continue 30 minutes of cardiovascular exercise
per day.
Protein: Maintain sufficient protein intake, which is based on
an individual’s Ideal Body Weight. Never let intake go below
80 grams per day.
Many severely obese women are also infertile, because the
fatty tissue soaks up the normal hormones and makes some
of its own as well. This completely confuses the ovaries and
uterus, and causes a lack of ovulation. However, as weight
loss occurs, this situation may change quickly. This happens
often enough for us to give special warning. You may start
planning a pregnancy after weight loss stabilizes. It is imperative not to become pregnant during the first year, since we
want both you and the baby to be healthy and safe.
If you become pregnant, along with extra servings of
protein, vitamins and blood tests, we ask that you arrange
for your OB/GYN to contact your surgeon’s office. They will
be able to discuss specific information about your surgery,
so the specialists can collaborate their efforts.
If you have a band, there is no need to deflate unless there is
inadequate weight gain or excessive vomiting. Call six weeks
postpartum for an evaluation.
Dumping Syndrome: Gastric Bypass Only
A concern after Gastric Bypass surgery is a condition called
“dumping syndrome” in which there is discomfort following
eating or drinking. The dumping syndrome consists of mild,
moderate or severe abdominal pains and cramping. It can
produce diarrhea, lightheadedness, sweating, palpitations,
weakness, cold sweating, dizziness, nausea and vomiting.
One can also experience fainting. In simple terms, the rapid
movement of food from the stomach into the small intestine
causes this syndrome. Remember not to have liquids with
any solid food or close to eating times since liquids mixed
with the dry/solid foods causes faster movement into the
Patient Education Handbook 28
small intestine. Other causes are ingesting high amounts of
sugar/fat/ spices, drinking with/after meals, and eating too
fast. Recommendations to help prevent dumping include
six small meals throughout the day, avoidance of sugar
and desserts (simple carbohydrates digest faster and move
quicker through the system), avoidance of alcohol and sweet
carbonated drinks. Follow your dietary recommendations
closely and you should not experience dumping syndrome.
If you experience dumping syndrome lie down with a wet,
cool washcloth to your forehead. Taking a nap might be
helpful as well. The symptoms will pass but the syndrome
can last up to 2 to 3 hours.
Remember there is hidden sugar and fat in many foods that
can cause a “sneak” attack even when you feel that you have
been exceptionally vigilant! Barbeque sauce that is eaten out
at a restaurant is a frequent culprit. When you cannot read
a label and you venture into the unknown be forewarned
that the situation can lead to a bout of Dumping Syndrome
that you didn’t bargain for. By being vigilant and educating
yourself about how much sugar and fat are generally in
certain foods you can be on the lookout so that you don’t get
ambushed when you are doing your best to avoid problems.
The following list are other terms for sugar. If you are a
Gastric Bypass patient then you will want to learn this list
and read food ingredient labels on any foods/liquids that
you consume. If any of these ingredients are in the top 3 or 4
ingredients then you should avoid it as it’s too concentrated
in sugar and will likely cause dumping (remember that
dumping can occur if you consume more than ~ 10gm of
sugar at any one time).
Other terms for sugar:
• Lactose
• Invert sugar
• Honey
• Granulated sugar
• Glucose
• Fruit sugar
• Fructose
• Molasses
• Raw sugar
• Sorbitol
• Sorghum
• Turbinado sugar
• Xylitol
• Maple sugar
• Maple syrup
• Mannitol
• Maltose
• Levulose
• Dextrose
• Corn sweeteners
• Corn syrup
• Confectioner’s sugar
• Brown sugar
•C
onsume foods made with artificial or natural sweeteners
such as saccharin, aspartame, or Splenda, Stevia or Truvia.
•A
void items artificially sweetened with sugar alcohols
which may cause a laxative effect and cause dumping
syndrome. Usually a warning is on the label of products
that contain sugar alcohols.
Depression
Our experience has shown us that in the period of stress, starvation, weight loss and the many lifestyle changes that occur
following weight loss surgeries, mild to severe depression is a
frequent problem. Unfortunately, most depressed people do not
recognize their depression. You and your family need to
be aware of the risk of depression in the recovery period
and should look for the signs of depression. Such signs
and symptoms can include: persistent sadness, anxious
or “empty” mood, loss of interest or pleasure in activities,
including sex, restlessness, irritability or excessive crying,
feelings of guilt, worthlessness, helplessness or hopelessness,
sleeping too much or too little, early morning awakening,
decreased energy, fatigue, feeling “slowed down.” Symptoms
also include thoughts of death or suicide and difficulty
concentrating, remembering or making decisions.
Persistent physical symptoms that do not respond to usual treatment are also signs of depression. Do not ignore these symptoms
or be worried or ashamed of them.
Effective drug and psychological treatments for depression
are available. With treatment, patients can improve and
return to normal quickly. You must contact your primary
care doctor, your psychiatrist or your psychologist who
helped in your preoperative evaluation to assist you with
any depression problems. If you need help contacting a
psychologist in your area, notify the office. Severe depression cannot be treated with medication alone. If you feel
you are suffering from severe depression it is a requirement
that you seek help from your doctor or your therapist in addition to taking the medication. Sometimes just a few visits
with a professional counselor who is trained in working
with weight loss surgery patients is all that it takes to get
you back on the road to health and happiness.
If you have been taking antidepressants before your weight
loss surgery, continue to take them after your surgery as
prescribed. You must contact the physician who prescribed
these medications for you for refills.
Long Term Complications
Late complications with bariatric operations have been
gratifyingly low.
The most frequent late complication is weight gain due to
enlargement of the pouch, enlargement of the outlet, and
last, but not least, patient non-compliance. Re-operation for
the first two causes gives the patient a "second" chance.
The development of gallstones is related to the rapid and
significant amount of weight loss and therefore is highest
in the first six months after surgery. Gallstones are not a
complication of surgery as such, but rather a complication
of rapid weight loss. Obese persons have a very high rate of
gallstone formation compared to normal weight persons,
mainly because of the many diet/weight loss episodes that
obese persons undergo. By age 50, nearly 50% of morbidly
obese women have developed gallstones.
A bowel obstruction due to a blockage from adhesions (scar
tissue) can occur as it can after any abdominal operation,
trauma, or intra-abdominal infection.
A stomal ulcer is an acid-peptic ulcer that occurs on or near
the anastomosis (connection) between the stomach pouch
and the bowel of gastric bypass patient. An ulcer may also
rarely occur in the usual duodenal ulcer position. There is
a higher risk of developing ulcers after bariatric surgery.
Patients who use non-steroid anti-inflammatory drugs
(NSAIDs) such as ibuprofen, Aleve,® etc. and smokers have
an even higher incidence of ulcers. They can be treated
with the same kind of drugs that are currently so popular
for the treatment of duodenal and stomach ulcers. In rare
instances, surgery is required as treatment.
LAP-BAND® patients may experience pouch dilation. A
possible band slip can occur if guidelines are disregarded
and can require medical attention.
Late stomal stenosis, or narrowing of the outlet of the
stomach pouch, is a complication that can occur in gastric
bypass patients and gastric sleeve patients. This condition
often requires a re-operation.
Iron deficiency anemia is a complication of significance in
the long term. It usually occurs in menstruating women
who do not take extra iron supplements. It is almost
always preventable. It is not difficult to treat, but must be
recognized in order for it to be treated. This is one of the
Patient Education Handbook 29
surgeons do an adjustment without the use of X-ray dye or
machine. Ask your surgeon and/or nurse which technique
they will use.
important reasons for long term follow-up. Read more
about the needed supplements in the diet guidelines.
LAP-BAND® Patient Guidelines
The liquid portion of the post-procedure diet has been
shown to be helpful when some patients develop swelling at
the band site post-surgically. Please follow the same dietary
guidelines so that your procedure has the chance to be as
problem free and successful as possible.
The LAP-BAND® patient will have visits at one month
intervals for the first six months. You will not feel early
satiety and/or a prolonged feeling of fullness until your third
to fourth adjustment. Your first adjustment is not until one
month after your surgery.
On the day of your adjustment your surgeon and/or nurse
will lay you down on an exam table or an X-ray table. Some
surgeons use an outpatient imaging center. Your surgeon’s
office will let you know where to go for your adjustment. The
LAP-BAND® reservoir port site will be exposed and cleaned
with an anti-septic. Some surgeon’s use some local anesthesia
to numb the area. The adjustment needle is placed through the
cleansed and numbed area into the port site. Once the needle
is in, the surgeon/nurse adjusts the band to a specific volume (a
number followed by cc’s or ml’s).
LAP-BAND® adjustments sometimes require the use of
X-ray equipment to see the band. Your surgeon and/or
nurse at the time of the adjustment may ask you to swallow
some X-ray dye to make sure the band is in the right
position or to ensure that the adjustment has not completely
blocked your stomach. Not all surgeons do this. Some
Patient Education Handbook 30
The day you are scheduled to have an adjustment to your
band, it is recommended that you only consume liquids that
day, to avoid the possibility of vomiting. Try not to drink
anything for about three (3) hours before your scheduled
adjustment. Once you have had your adjustment completed,
it is recommended you stay on a liquid diet for 2 to
3 days afterwards. Sometimes the adjustment can irritate
the stomach and eating solid food immediately after an
adjustment can produce vomiting, which could produce
a band slip. That is something everyone wants to avoid,
because surgery is required to fix a Band slip. During the 2
to 3 days after the adjustment, make sure you are consuming
fluids to keep yourself hydrated. Protein drinks at this time
will help make sure you are keeping yourself nourished.
Continue to take your vitamins and supplements, but not on
an empty stomach. Protect your stomach and yourself so as
not to have problems after your adjustment.
After your adjustment it is not uncommon to have some
soreness at the injection site. Tylenol and hot packs should
help. Bruising is not unusual either. Extreme swelling, redness, bulging, pain, heat or drainage should be called to your
surgeon’s immediate attention.
LAP-BAND® patients must follow the dietary guidelines
closely to decrease the incidence of vomiting. Vomiting
excessively can cause the band to slip which can possibly
require surgery to correct it.
If you experience unrelenting vomiting, non-stop nausea or
cannot even swallow your saliva, this can be signs of a Band
slip. Call your surgeon immediately. If you can not reach
your surgeon, go to your nearest emergency room for
assistance. A band slip requires immediate attention.
Fever and chills within 4 days after LAP-BAND® surgery
should be reported to your surgeon. Redness, drainage that
is white or cloudy, or swelling from any of the LAP-BAND®
incision sites should be reported to your surgeon immediately. If your surgeon is not available, go to your nearest
emergency room.
Problems related to the LAP-BAND® may require one or
more X-Ray dye studies to determine the position of the
band or problems with the band. An Upper GI study may be
ordered or a CAT scan may be needed. This will be ordered
by your surgeon.
What We Have Learned from Experience
Frequent snacks slow down weight loss; however, you
should not go long periods without any food. You will be
more prone to overeat later and not meet your protein
requirements. Try to eat three low starch, high protein,
nutrient dense meals and one protein snack per day –
every day. It is not uncommon to feel full after just a
couple of teaspoons of food initially after surgery. Between
meal snacking or
“grazing” on small
amounts of food
throughout the
day will sabotage
your weight loss
and result in the
inability to lose an
adequate amount of
weight. Your body
needs a minimum
of 80 grams of protein each day. You need the protein to
preserve your lean muscle mass, which in turn is going
to help you continue to lose weight. You also need lots of
protein for your body to heal properly. The primary source
of nutrition should be protein. 70 to 75% of all calories
consumed should be protein based (eggs, fish, meat, etc).
Carbohydrates (bread, potatoes, etc.) should make up only
10 to 20%, and fats (butter, cheese, etc.) only 5 to 15% of
the calories that you eat. A diet consisting of 600 to 800
calories and 75 grams of protein should be the goal for the
first 6 months. In the beginning, this may force you to eat
mostly protein in order to reach the minimum requirement
of protein.
Eating Techniques
Your new motto: “slow, small, moist and easy”.
Especially in the first 8 weeks after surgery, you need to
change your eating habits to avoid pain and vomiting,
rupture of staple lines and to aid in weight loss. At this time,
the tissues around the staples and sutures in the stomach
pouch are very swollen and need to heal. You also want to
prevent obstruction of the area where your stomach pouch
connects to your intestines (stoma).
Swallowing food in chunks may block the stoma and
prevent foods from passing into the intestine. It is
CRITICAL that you eat slowly and chew your food well to
lower the risk of getting anything caught in this area.
You may find the following tips helpful:
• Set aside 30 to 45 minutes to eat each meal. Aim to chew
your food 25 times with each bite. Ground or soft foods
may be necessary if you have dentures. Slow down – we
have a lifelong habit of eating too fast. Slow down, enjoy
the food and relax.
• Explain to friends and family why you must eat slowly so
they do not urge you to eat faster.
• Take small bites of food and, for a visual aid, you may
want to use a saucer in place of a plate to help with
portion control.
• Pay attention to taste; learn how to savor your food.
• Eat only at meal times. Between meals snacking or
“grazing” on small amounts of food throughout the day
will sabotage your weight loss and result in the inability
to lose an adequate amount of weight.
• Never drink liquids when eating solid foods. Liquids
should be avoided for a period of 30 minutes before and
30 minutes after eating solid food or meals. Combining
liquids and solids may cause nausea, as well as push foods
through the stomach pouch faster, enabling you to eat
more.
• Stop eating as soon as you are full (over-eating even one
ounce can make you vomit and can lead to stretching
your pouch). Listen to your body’s signals, not the food
left in your plate.
• Only eat the best of foods – after all, if you are going to
eat so little, shouldn’t you have the best?
Recognizing Fullness
It is often difficult to understand the meaning of new sensations. Indications of fullness may not feel the same as
before surgery. Here are some that are not as obvious, but
a sure sign that your pouch is nearly full:
• A feeling of pressure or fullness in the center of your abdomen, just below your rib cage. A feeling of nausea, regurgitation or heartburn. You may have a feeling of satiety several minutes after you are actually full. If your pouch is 30cc (one oz.), you can put 30cc in it, and you will not feel full for about 5 minutes. Try this to help you find out the right portion size:
• Eat slowly. Chew slowly and thoroughly at least 25
times! Put your utensils down on the table after every
bite. Remember that the pouch can only hold a small
amount of food and it is best not to stretch the pouch
by forcing food. Do not overeat. Listen to your body’s
signals – do not look at the food left on your plate.
Patient Education Handbook 31
• Over the long term, good, well-balanced nutrition is
important: Protein first (beans, tofu, tempeh, eggs,
fish, seafood, dairy products, poultry, and meats), then
vegetables, and then complex carbohydrates. To use
protein properly, your body needs adequate amounts
of complex carbohydrates.
Do not overcook your meat as this makes
it difficult to digest. Grill or broil, if possible. Do
not deep-fry your food. You will notice that it is easier
to eat protein rich foods if they are moist and juicy. An
example would be chicken thigh meat versus breast meat.
Even though you may not always experience “dumping
syndrome,” too much fruit, fruit juice, sugars and soft
drinks will slow down your weight loss. It is best to restrict
them all to allow your surgery to work for you. Even when
a fruit product claims “unsweetened” that only means
that there is no added sugar. The amount of natural sugar,
however, is often substantial. Noncarbonated diet beverages
are permitted after a certain time. However, too many
diet beverages can cause water retention and diarrhea.
Moderation is best. Introduce one food at a time in order
to rule out food intolerance. Don’t be afraid to try new
foods, but in small amounts to start. Many foods are going
to be trial and error. What does not agree with you now
may be acceptable in a few more weeks. Keep in mind that
one day, foods may be tolerated smoothly, while the next
you may have some fullness or discomfort. These problems
eventually disappear, so don’t be discouraged if they happen
occasionally. Labels are a great source of information.
They give you in-depth information about the product you
are purchasing with regard to the amount of fat, protein,
carbohydrates, sugar, and fiber it contains. Become a label
reader and become more aware of what you put into your
body. Remember that it is okay to get pleasure out of food.
Since you are restricted to small portions, we encourage you
to become a gourmet and only have the best! Make your
dish visually appealing with beautiful tableware and enjoy
your meal.
Goal Buster Foods
Remember to limit the following junk foods as you advance
your diet as they will impede weight loss:
•
•
•
•
•
•
•
Candy/candy bars
Chewing gum
Sugar or syrup
Sugar-coated cereals
Cake or sweet rolls
Molasses
Cookies/pies/pastries
Patient Education Handbook 32
•
•
•
•
•
Sweetened fruit
Sweetened condensed milk
Jam/jelly
Ice cream
Honey
These foods add extra calories and can affect weight loss and
can also cause dumping.
Fluids
Drink 48 to 64 oz. of water per day, between meals (increase
this amount by 20% if you are sweating). Recommended
beverages are water, or if desired, unsweetened, low calorie,
and non-carbonated drinks.
Juices are high in calories, could make you dump and
provide very little nutritional value.
Lifetime Dietary Recommendations
After 9 weeks you should be back to a regular diet. At this
point you want to make sure that you are compliant with the
following dietary recommendations the majority of the time
for the rest of your life. Weight loss surgery patients who
follow these recommendations on a consistent basis lose
significantly more weight and experience significantly fewer
complications than those patients who don’t.
1. Consume Protein at every meal and at the beginning
of every meal. Examples include (boneless skinless
chicken thigh, any grilled baked/fish, small rib-eye steak
with visible fat removed, low fat cottage cheese, low fat
string cheese, Canadian Bacon, thin sliced turkey breast,
protein shakes). Remember to stay away from dry/tough
meats. Female LAP-BAND®/gastric sleeve patients need
at least 80gm protein/day. Males need at least 100gm/
day. Add 20 grams to this value if you are a bypass
patient. See chart on page 41 for your height/weight.
2. Consume Veggies – at least 1/4th cup of low-starch
vegetables at lunch and dinner daily. Examples include:
broccoli, cauliflower, zucchini, yellow squash, cabbage,
salads, etc. These foods fill you up and help preserve
lean muscle mass and bone tissue.
3. Avoid Refined Carbohydrates/starches and high sugar
foods. Stay away from the white rice, white pasta, white
bread. These foods will make it difficult to lose weight
and they cause a lot of GI distress. Also, stay away from
any high sugar foods as they will impede your weight
loss and will cause Dumping Syndrome in gastric bypass
patients.
4. Avoid Liquid Calories! Remember to eat your calories
and not drink your calories!! Liquids are absorbed
just as fast after your weight loss surgery as they were
before your weight loss surgery and the excessive intake
of liquid calories (milk, juice, soft drinks, regularly
sweetened tea/coffee, energy drinks, and soft liquid
foods like creamed soups) will hinder your weight loss.
5. Eat Breakfast. Try and eat a solid breakfast if you can
tolerate it; however most band patients can’t tolerate
a solid breakfast as the band is tighter in the morning
than at night. If you can’t tolerate a solid breakfast,
then consume a high protein/low calorie and low
carbohydrate meal replacement drink such as: Bariatric
Advantage Meal Replacement, Myoplex Light, or EAS
AdvantEDGE Carb Control. Breakfast controls your
appetite and stimulates your metabolism (rate at which
you burn energy)
6. Eat Every 3 to 4 hours – But no More/Less Frequently
than this. Make sure and consume a small (3 to 4 oz.)
high protein meal/snack every 3 to 4 hours. This will
help control your appetite, ensure adequate protein
intake, and prevent blood sugar lows (hypoglycemia).
On the other end of the spectrum, don’t eat more
frequently than this. Some weight loss surgery patients
eat VERY small amounts of food (1 to 2 oz.) every 30
minutes or so and never feel a sense of fullness. This is
known as grazing, and this can negate the effects of the
surgery and cause you to over consume calories. All of
the weight loss surgery procedures are designed to make
you feel full after consuming less than 1 cup of food and
to keep you full for a good 3 to 4 hours. So, make sure
and consume close to this amount (but not much more)
at each meal and snack and then stop eating at that
point.
7. Avoid Carbonated Beverages. This can both cause band
slippage in LAP-BAND® patients and cause the size of
the pouch/stomach to increase and hold more food.
8. Eat Slowly (take at least 20 minutes per meal/snack).
Eating too quickly will cause dumping in the gastric
bypass patient and possibly in the Gastric Sleeve patient.
Eating too quickly can also overfill the pouch in the
bypass patient and allow it to stretch and hold more
food/liquid over time which will impede weight loss
long-term. A LAP-BAND® patient who eats too fast will
experience vomiting.
9. Take Vitamins/Minerals daily. As discussed earlier,
the weight loss surgery patient is at increased risk
for nutrient deficiencies. However, this risk is easily
avoided by taking all of your recommended vitamins/
minerals on a regular basis. Vitamin/Mineral
deficiencies can lead to a host of health problems and
significantly impact your weight loss.
10.Don’t Consume Liquids 30 minutes before, during and
up to 30 minutes after eating. Drinking with meals
can cause vomiting in all weight loss surgery patients.
In the band patient it may push the food too quickly
through the band and result in a lack of fullness (causing
increased calorie intake). Fluid intake with/after meals
will cause Dumping Syndrome in the Gastric Bypass
patient. A small sip of liquid to moisten your mouth is
ok, but don’t use more than that unless instructed by
your physician.
11. Consume 48 to 64 oz. of fluid daily between meals/
snacks. Now that you are no longer drinking with
meals your risk of become dehydrated is significantly
increased. So, make sure and keep bottle of water,
Crystal Light, Propel Zero or protein flavored water
handy between meals and constantly sip on it between
meals to avoid becoming dehydrated. Note: When you
are back to solid foods you should not consume more
than 1 cup of food within an hour; however, feel free to
consume more than 8 oz. of liquid if you can as liquids
pass into the intestines quickly and will not stretch the
pouch/stomach after your sutures have healed (about 4
weeks after surgery)
12. Attend Group Support Meetings. Research has shown
that the most successful weight loss surgery patients are
those who attend group support meetings on a regular
basis. If you can’t attend ours then try to find one in your
local area that you can attend as your success depends on it.
We offer convenient online seminars. Visit our website for
more details.
Power of Protein
As mentioned throughout this booklet, consuming adequate
amounts of protein is important to ensure adequate weight
loss and to prevent complications. But what is so important
about protein, what are some good sources of protein, and
how much do you need? These are all questions that you are
probably asking yourself, so we have written this section to
help you answer these questions.
Why Protein is SO IMPORTANT
Adequate protein consumption helps you maintain your
lean body mass (muscle mass) while you lose fat. This is very
important because muscle helps keep your resting metabolic rate (the rate at which you burn energy at rest) high.
By consuming adequate protein daily and by performing
weight bearing type exercises (before surgery and after when
cleared by your surgeon) you will maintain the majority of
Patient Education Handbook 33
your muscle, or even add some muscle. This will ensure that
your body stays/becomes a fat burning machine. On the
other hand, if you fail to consume adequate protein intake
daily, and fail to perform resistance type exercise regularly,
then your muscles will wither away. As a result, your resting
metabolic rate will come to a crawl and you will find it difficult if not impossible to lose fat!
Adequate protein is required to maintain a strong immune
system and to form strong hair and nail tissue. If you don’t
want to get sick often, and if you want to have strong/
healthy nails, then it’s important that you meet or exceed
your protein goal on a daily basis.
Adequate protein intake before and after surgery helps your
surgical wounds heal significantly quicker.
Protein fills you up quicker and keeps you full longer than
carbohydrates or fat. Therefore, eating protein at every meal
and at the beginning of every meal will ensure that you
consume significantly less calories without feeling deprived.
As a result, you will lose significantly more weight.
Some Important Advice About Protein
Make sure you consume good quality protein sources at
each meal such as: Lean ground beef, small ribeye steak
with visible fat removed, baked/grilled and boneless/skinless
chicken thigh, homemade sliced turkey breast, grilled/baked
fish, Omega 3 Eggs, egg whites, low fat string cheese, low fat
cottage cheese, Canadian bacon.
Make sure you consume protein at the beginning of every
meal before you eat anything else!!! This is important
because if you were to consume your veggies, carbs, fats
and fruit first, then you would be too stuffed by the time
that you got to your protein food to be able to consume all
of it. Therefore, you would end up skipping it and be at risk
for a slow rate of weight loss, infections, and poor wound
healing. So, make sure you eat protein at every meal and at
the beginning of every meal!!
When using protein supplements ENSURE THAT THE
SOURCE OF PROTEIN IS WHEY PROTEIN ISOLATE
or at a minimum Whey Protein Concentrate!! Any other
form of protein including: collagen protein, soy protein,
rice protein, pea protein, etc… will not provide your body
with the optimal amounts of essential amino acids that it
needs to function correctly. Please…don’t settle for any
imposters!
Patient Education Handbook 34
How Much PROTEIN Do I Need???
Protein is especially important after weight loss surgery.
Everyone must consume a minimum amount of protein
each day to maintain their health. Please find your height
on chart provided (page 40) and see your estimated
protein needs beside it. This is the minimum amount of
protein (listed in grams) to consume on a daily basis. Most
individuals should follow these guidelines unless other
health conditions prevent you from doing so. If you have
any questions please ask your dietitian.
Add 20gm to your value if you are a
Gastric Bypass patient!
Post Surgery Diet: Week One – Clear Liquids
• Starting the day of sugery (lap-band patients) or the day after surgery (gastric sleeve and gastric bypass patients) your
surgeon will start you on a Bariatric Clear Liquid Diet. This diet is designed to prevent nausea and to prevent band
slippage (band patients) and staple line rupture (sleeve and bypass patients).
• While on this diet you can safely consume unlimited amounts of:
- Water
- Broth
- Crystal Light
- Diluted juice (50% juice and 50% water)
- Sugar free Jello-O
- Sugar free ices/Popsicles
- G2 Version of Gatorade
- Powerade Zero
- Vitamin Water Zero
- Unsweetened or artificially sweetened tea and coffee (no more that 2 cups/day)
- 2-3 clear liquid protein drinks such as isopure and nectar
- fruit flavor protein powders (available in office or online)
• As you can see, this is essentially the same diet you completed the day before surgery, but now:
– Your liquids should be sugar free/very low sugar only!
– You are consuming a clear liquid protein drink 2-3 times daily as tolerated!
* NOTE: During the first few days after surgery some patients notice excessive nausea from protein drinks.
If this is an issue for you, then you can safely
Hold the protein drink for up to four days after
surgery. You will need to restart it as soon as
possible in order to prevent protein deficiency
Weight Loss Tip:
During this phase you will want to start taking all
of the recommended vitamins and minerals as listed
on page 19. Vitamins and minerals help prevent
nutrient deficiencies and they help your body burn
fat efficiently. A body that is not properly nourished
won't let go of fat easily.
* Vitamins can be postponed until day 5 post-op if
you are experiencing nausea/vomiting.
Patient Education Handbook 35
Week 2 Full Liquids
• Consistency: drinkable, pourable! There should be no chunks, seeds, skins, etc.
• Examples:
- Meal Replacement Shakes (Bariatric Advantage or EAS AdvantEdge are good options)
- Nonfat or 1% milk
- Broth and cream of vegetable soups that have been blended to liquid consistency and strained.
- Sugar free pudding or yogurt
- Any sugar free/very low sugar clear liquids from week 1
- Any sugar free clear liquid
- Full liquid diet recipes can be found on the next page
• If you are not reaching your protein needs easily, another option for you is to purchase unflavored
whey protein powder to add to any of your full liquids.
Weight Loss Tip:
At this stage, your goal is to start reducing or
eliminating clear liquid calories like sodas, sweet
teas, juices, etc. Make this a lifestyle change to
prevent any weight regain. Find non-calorie drinks
that you absolutely love so you won't miss the sweet
drinks!
Patient Education Handbook 36
Post-Op Week 2 Recipes
Orange Protein Shake
1 cup 100% orange juice
2 scoops vanilla protein powder
1/2 cup ice cubes
2 tbsp. Cool Whip lite
Put all ingredients in blender. Blend until smooth.
caution: When using this recipe do not drink but 2 oz. at one time due to the sugar content of the orange juice.
Peach Smoothie
6 oz. 100% Peach Nectar or juice
1/2 cup low fat cottage cheese
Blend well. Strain if necessary to remove any unblended pieces.
Super Peanut Butter Cup Shake
1 cup evaporated skim milk
2 scoops chocolate protein powder
1 cup ice cubes
1 tbsp peanut butter
1/2 tsp vanilla extract
Place all ingredients in blender and blend on high until smooth
Vanilla Shake
1/2 cup skim milk
3 pkts Equal sweetner
1 tsp vanilla extract
3 ice cubes
1 scoop vanilla protein powder
Place all ingredients in blender. Blend 2 minutes
using high speed or until ice cubes are melted
High Protein Cream of Vegetable Soup
1 ¼ cups water
1 cup vegetables, chopped (fresh, frozen or canned)
1 cup skim milk
1 ½ tbsp. cornstarch
¾ tsp. onion, dried
Dash pepper
1/8 tsp. basil, dried
1/8 tsp. thyme, dried
½ tbsp. instant bouillon
¾ cup nonfat dry milk
Combine vegetables and water in saucepan. Cover and cook
until vegetables are tender and set aside. Combine other ingredients. Mix well. Cook over low heat, stirring constantly to avoid
scorching, until thickened. Add vegetables and the water in which
they were cooked. Mix in blender until completely smooth. Heat
thoroughly. Strain before eating. Put everything in blender and
blend until smooth.
Patient Education Handbook 37
Weeks 3 and 4: Soft Foods
• Starting 3 weeks after your surgery you can start adding soft foods such as:
- Grilled/baked fish
- Chicken salad (made with light mayo or light Miracle Whip)
- Tuna salad (made with light mayo or light Miracle Whip)
- Egg salad (made with light mayo or light Miracle Whip)
- Thinly sliced chicken or turkey lunch meat
- Refried beans with mozzarella cheese melted in
- Cottage cheese with canned fruit
- Canned fruit (canned in juice only and drained)
- Well cooked non-gassy vegetables such as: green beans,
squash, carrots, zucchini, and spinach
- Oatmeal
- Small amounts of potatoes (without skin)
Weight Loss Tip:
Starting now and from here on out you will want
to make sure and consume high protein foods like
meat, poultry, fish and cheese at each meal and
at the beginning of each meal before you consume
anything else. Failing to eat your protein first can
cause you to become full and skip your protein.
Simply put, if you do not meet your protein needs
you will not acheive your weight loss and health
goals!
• While on a soft diet you will need to avoid:
- Spicy foods
- Skins of tough fruits and vegetables such as potatoes, apples, pears, cucumbers, etc...
• Starting now and from here on out you will need to:
- Eat slowly. Taking 20 minutes/meal will help prevent nausea, vomiting and diarrhea that
may result from eating too quickly.
- Limit liquids from 10 minutes before meals and up until 30 minutes after meals.
Drinking liquids during and after meals can cause vomiting and diarrhea.
ATTENTION:
*If unable to tolerate soft foods at this time (nausea, vomiting, discomfort, or significant pain), STOP consuming these foods
immediately! Go back to your full liquid diet until you feel comfortable to try soft foods again. Remember the following
guidelines when you are starting to introduce solid foods into your diet to prevent any GI complications:
1. Chew, chew, and chew some more! Do not swallow your food until it has been chewed to liquid consistency.
2. Eat slowly. Take about 15-20 minutes with each meal, even it if is just 2 ounces.
3. Stop eating at the first sign of fullness.
Patient Education Handbook 38
Weeks 5 and after: Regular Foods
• You are now able to eat regular foods as tolerated. Every person is different so find out what you can tolerate.
The best way to do this is to eat slowly!
• Recap of the nutrition habits you have already started to build:
- Eat around 3-5 small high protein, low carbohydrate meals per day
- Meet your protein goals
- Avoid liquid calories
- Chew each food well and eat slowly
- Choose moist cuts of meat and poultry instead of dry cuts
- Avoid mixing liquids with solids
- Take your vitamins and minerals
• Think: Slow, Small, Moist, and Easy!
• Choose wholesome, healthy foods most of the time and your body will love you!
• Remember it's okay to drink your protein if you are unable to get the solid food down.
**above all else, listen to your body. if a food or beverage causes you
discomfort, then do not consume it!**
The plate method of eating for weight loss surgery patients
Good Sources:
– Steamed broccoli
– Cauliflower
– Spinach
– Green beans
– Carrots
– Cabbage
– Zucchini
– Yellow squash
– Salads
Good Sources:
– Beans
– Oatmeal
– Potatoes w/skin
– Fruit w/skin
– Whole wheat
bread (toasted)
– Sweet potato
Good Sources:
– Boneless/skinless chicken thigh – Tuna salad – Egg salad – Low fat cottage cheese
– Low fat string cheese – small rib-eye steak with visible fat removed
Patient Education Handbook 39
WOMEN
Ideal Body
Weight
Estimated
Protein Needs
Here is a list of protein meal replacement shakes that have
our seal of approval:
4'10"
99
62
• Designer Whey Protein Powder (any flavor)
4'11"
105
66
5'0"
110
69
• Isopure (Clear and Full liquid premixed protein drinks
and powder)
5'1"
116
73
5'2"
121
76
5'3"
126
79
5'4"
132
83
• Designer Whey Protein-2GO
5'5"
138
87
• Premier Nutrition (premixed shakes)
5'6"
143
90
• EAS AdvantEdge Carb Control (premixed shakes)
5'7"
149
94
• Oh Yeah! (premixed shakes and powder)
5'8"
154
97
• Muscle Milk Light (premixed shakes and powder)
5'9"
160
101
5'10"
165
104
5'11"
171
108
6'0"
176
111
MEN
Ideal Body
Weight
Estimated
Protein Needs
5'2"
130
82
5'3"
136
86
5'4"
141
89
5'5"
150
95
5'6"
156
98
5'7"
162
102
5'8"
169
107
5'9"
176
111
5'10"
183
115
5'11"
189
119
6'0"
196
124
6'1"
202
127
6'2"
208
131
6'3"
214
135
Patient Education Handbook 40
• Bariatric Advantage High Protein Meal Replacement
Shakes (any flavor)
• Any Whey Unflavored Protein Powder
• Pure Protein (premixed shakes)
• Slim Fast Lower Carb Shake (not the regular Slim-Fast!)
• Unjury Protein (powder)
• Mix unflavored protein powders such as Any Whey and
Unjury (unflavored) mix into creamed soups, low sugar
applesauce, sugar-free puddings, mashed potatoes, hot
cereals, and skim milk and serve to significantly boost the
protein content of these foods without negatively effecting
their taste, color or texture. If you are not using one of the
above protein supplements or meal replacement shakes
on a daily basis then you need to ensure that you are
adding unflavored protein powder to foods on a regular
basis!
Protein Supplements to Avoid!!
The research suggests, and we do as well, that you avoid the
following brand name protein supplements as they contain
inferior sources of protein that will not provide your body
with the essential amino acids that it needs to function
correctly.
• Pro-fect • Proteinex • Pro-Stat • New Whey liquid protein
• Any collagen based protein supplements
• Low Carb Carnation Instant Breakfast
• Here is a list of quality protein sources that can be consumed when starting solid foods:
Examples of Animal Protein Foods
Amount
Grams of
protein
Beef, lean
1 ounce
7 grams
Cheese (American, cheddar, provolone, Swiss)
1 ounce
7 grams
Cheese, cottage
1/4 cup
7 grams
Cheese, riccota
1/4 cup
7 grams
Chicken
1 ounce
7 grams
Egg or egg substitute
1 egg
7 grams
Fish, any type
1 ounce
7 grams
Shrimp
1 ounce
7 grams
Milk, skim (recommended)
8 ounces
12 grams
Pork
1 ounce
7 grams
Turkey
1 ounce
7 grams
Yogurt, nonfat or low-fat fruit flavored
3/4 cup
12 grams
Yogurt, plain nonfat
3/4 cup
12 grams
Examples of Plant Protein Foods
Beans and peas (black-eyed, garbanzo, kidney,
pinto, split, white)
Cereal, ready to eat
Corn
Lentils
Lima beans
Non-starchy vegetables (tomatoes, green beans
cucumbers)
Oats
Pasta
Potatoes, baked or mashed
Soy burger, veggie burger
Soy milk
Tofu
1/2 cup
3/4 cup
1/2 cup
1/2 cup
2/3 cup
1/2 cup
cooked 1/2 cup
1/2 cup
1/2 cup
1 ounce
8 ounces
4 ounces
7 grams
3 grams
3 grams
7 grams
7 grams
2 grams
3 grams
3 grams
3 grams
3 grams
7 grams
7 grams
**As you can see, one ounce of most animal proteins = close to 7 gm of protein. so, if you
consumed 3 ounces of meat, poultry, fish, or cheese then you would have consumed 21 gm of protein.
By remembering that 1 ounce = 7 gm of protein you will easily be able to calculate how much protein
you consumed.
Patient Education Handbook 41
S ocial E vents
Overeating at parties is easy to do — especially when you are
having fun and you may be engrossed in a conversation. It
is also easy to keep munching beyond fullness. Snacking is
considered a bad habit after Bariatric surgery, since there is
nothing that prevents you from eating a tiny amount all day
long. Thus, make “party eating” one of your meals for the day.
Never munch directly from the bowl, which can make portion
control harder to estimate. Instead, place the food directly
on your napkin or small plate, and take only the food you are
planning to eat. Remember, you cannot eat more than a small
child’s portion now. Look for the protein items first. You can
then supplement your meal with other choices. Slow down
your eating so you can really enjoy the flavors of the food and
do not feel deprived as you finish your small portion. A party
is not a good place to try foods for the first time. You do not
want to end up ill and have to go home early. Instead, take
time at get-togethers to socialize more, have fun and enjoy the
people present.
Learn to eat more slowly, and deliberately to allow your body
to feel the fullness and to digest your food better. When you
eat too fast, you could overeat or not chew your food well
enough which could cause vomiting. Old habits will have to
be worked on until your new slow eating is your normal style
of eating.
E x ercise
First Steps
Your activity will be restricted to no strenuous activity for
three weeks after the operation. You may walk and perform
light household duties as tolerated upon your return home.
Usually, frequent walks of short duration are tolerated better
than one or two long walks that go to or past the point of
fatigue. Increase the distance that you walk gradually. By the
time you are 4 weeks post-op, you should be walking 30+
minutes 5 to 6 days a week, unless you have specific problems
with your weight bearing joints. In the latter case, water
exercises are recommended. You can start water activities
about three weeks after surgery.
Starting an Exercise Program
You are already aware that Bariatric surgery is merely a tool to
weight loss. Of course, this means that in order to receive the
maximum benefits from your surgery, you must incorporate
exercise into your daily routine. Patients and researachers
report that exercise is a key factor in the ability to maintain
weight. If you want to feel good and maintain and build
Patient Education Handbook 42
muscle mass, you must exercise. Exercise helps you lose
weight and stimulates the production of “the good feeling”
hormones called endorphins. Exercise also helps to keep
your bone tissue dense and strong, increases strength and
balance, boosts energy and improves quality of life. Research
has shown that patients who exercise 3 or more times per
week for a minimum of 30 minutes lost an additional 12%
of their excess weight in 6 months. The mistake that many
patients make is that they do not exercise until they feel
“all recovered” or try to start exercising when they realize
they are not on course to reach their goal weight. Patients
who work hard on exercise soon after surgery find it very
rewarding. As the weight falls off, the capacity for exercise
improves dramatically, with significant improvements
on a week-by-week basis. Do not cheat your body of
this important aspect of weight loss. Make a long term
commitment to exercising!
Yes, exercise is hard. It is difficult to stay motivated. It is
not easy to find an exercise that you may like. Try to look
into forms of exercise that you may have never tried before.
Explore yoga, dancing, roller skating, tai-chi, etc… Exercise
does not mean that you have to be in a gym for hours a day.
If it has been some time since you have exercised regularly,
then it is best to start slowly. Begin with as little as 5 minutes
a day and add 5 more minutes a week until you can stay
active for 45 minutes per day. We recommend that you make
exercise part of your daily routine. Just being an active person is
not enough exercise to be able to lose the weight and keep it off.
There are three forms of exercise:
• Cardiovascular
• Strength-building
• Flexibility
Cardiovascular exercise is also known as aerobic
exercise. Aerobic exercise uses your large muscles and
can be continued for long periods. For example, walking,
jogging, swimming, and cycling are aerobic activities.
These types of exercises drive your body to use oxygen
more efficiently and deliver maximum benefits to your
heart, lungs, and circulatory system. A simple definition
of cardiovascular exercise is any exercise that raises your
heart rate to a level where you can still talk, but you start to
breathe harder. Your goal is to lose weight; you will need to
do some form of cardiovascular exercise for 5 or more days
a week for 30 to 45 minutes or longer.
Strength-building exercises are known as anaerobic exercise. Anaerobic exercise does not have cardiovascular benefits, but it makes your muscles and bones
stronger. Strength-building exercises require short, intense
effort. People who lift weights or use any type of equipment
that requires weights are doing strength-building exercise.
Strength-building exercise makes your muscles and bones
stronger and increases your metabolism. Your muscles
use calories for energy even when your body is at rest. So,
by increasing your muscle mass, you are burning more
calories all of the time. If you strength train regularly, you
will find that your body looks leaner and you will loose
fat. Strength building exercises should be performed 2
to 3 times a week for best results. Always warm up your
muscles for 5 to 10 minutes before you begin lifting any
type of weight or before performing any resistance exercises.
Flexibility exercises, which are also anaerobic, tone
your muscles through stretching and can prevent muscle
and joint problems later in life. A well balanced exercise
program should include some type of each exercise from
each category.
Loss of Bone and Muscle Mass
When the body is in a state of stress, and trying to combat
starvation and malnutrition, it hoards its precious fat until
any other usable fuel has been burned. Practically, the
body will prefer to burn muscle mass, before consuming its
precious fat. If muscle is not regularly used for exercise, like
every day, it will be consumed to meet the energy needs.
This concept is similar with calcium stores. Calcium is
stored in the bones. Strong bones require calcium, phosphorous and other nutrients in addition to weight bearing
exercise. Obese persons tend to have strong bones because
of their obesity. When major, rapid weight loss occurs and
adequate mineral supplementation is lacking, osteoporosis
is more likely.
Loss of muscle mass and osteoporosis are preventable.
Follow the nutritional guidelines in the Diet section to
maintain optimal nutritional status. In addition, it is very
important during active weight loss to exercise vigorously
every day. We recommend at least 20 minutes a day of
aerobic exercise and weight bearing exercise.
Devote attention to the upper body strength as well.
Many persons find, after a few weeks or months of regular
exercise, that they actually begin to enjoy it, and start to
work out even more! Fairly vigorous exercise, for more than
half an hour every day can greatly enhance fat-burning, and
hasten weight loss. Our research has shown that patients
who exercised at least three times per week for at least half an
hour lost 12% more of the total excess weight after surgery. It
also builds a healthy and beautiful body.
Obese persons are very strong and powerful – after all, just
getting out of bed, you lift more than some people pick up
all day long! It would be upsetting to have this muscle power
lost, especially when you need it to enjoy life. Save your
muscles, keep your energy, eat your protein and EXERCISE!
Ten Tricks for Sticking with the Program
1. Look at exercise like a prescription medication. You do
not have to like exercise, but you need to do it in order
to stay healthy. You also have to do it in order to lose
weight. No miracles here. If you have a condition that
requires a medication every day, you are going to take
this medicine every day. Your body needs exercise every
day, so you have to give it what it needs.
2. Do research. Find out what types of classes your local
gym is offering. Does your hospital offer water exercise
classes for people with arthritis? Is there a gentle yoga
class offered at the community center? You have a greater
likelihood of continuing with an exercise that is tailored
to your needs and that you enjoy. Explore new types of
exercise.
3. Change your routine. So you love to walk, but you are
bored with it. Sometimes, just changing the direction of
your route can make all the difference. Find new places
to go walking, change the time of day, or offer to walk
your neighbor’s dog.
4. Find a buddy. Let’s face it, without a coach most athletes
would not be where they are now. Why should you be
any different? We all need someone to nudge us and
make us go the extra mile, especially when it comes to
exercise. Find a friend, a neighbor or personal trainer to
meet you at the gym or in the park.
5. Find your rhythm. Listen to music or books on tape or
meditation while you exercise. 15 minutes on the bike
can seem like an eternity without music, but with the
right music to occupy your brain, it will not seem so
long.
6. Participate in group sports. You don’t need to join
the soccer team, but participating in a group activity
increases the chance that you will stick to it. Choose
water exercise, yoga, or stretching classes. Choose places
and times where there are other people who are actively
involved in exercise.
Patient Education Handbook 43
7. Know what makes you give up the program. If going
on vacation throws you off your fitness plan, try
incorporating exercise into your vacation. If boredom
makes you give up, stay interested by changing
8. Make a schedule. If you don’t put exercise into your daily
schedule, most likely you will do everything but exercise.
Plan in babysitters. Schedule specific activities on
specific days, like walking 20 minutes on Monday, yoga
class on Tuesday, etc…
9. Use a workout log. Write down the exercise you do
and see how you have improved. Just like weight loss,
sometimes one does not see the scale drop, but the
inches seem to melt away. It is difficult to keep up with
exercise when you do not see the results. Write down
the number of repetitions, the weight used, the length of
walk, the time, etc…
10. Stay active between workouts. Walk as much as possible
between workouts. Park farther away. Get off the bus a
couple of stops early. Always keep a good pair of walking
shoes in your car, should you have unexpected time to
take a walk.
The Walking Workout
Recent research indicates that walking is one of the best
ways to be in charge of your life. Besides the well documented health benefits, the beauty of walking is you can do
it at your own pace. Walking is the first type of exercise that
we recommend, both before and after surgery.
If you are new to exercise and you are also recovering from
surgery, you can walk 10 to 20 minutes four or five days a
week. As you get stronger, you can increase the distance and
the speed to your comfort level.
As with any type of exercise, it is still important to warm up,
then stretch. Start by walking for just 5 minutes and then do
a few gentle stretches. Your muscles will stretch better if you
walk a little first. Ask a fitness professional which stretches
are best for you. You can also order LifeWalk™ Easy Audio
coach tape (888-LIF-WALK), which offers practical tips for
getting the maximum aerobic, strength, postural and conditioning out of your walking program. Ask the front office
desk if you are interested.
Consistency is probably the most important part of your
walking routine. The more time you can devote to walking
each day, the healthier you’ll be. Remember that short walks
are better than none at all. Health, like life, is a journey.
What you need to do is take the first step.
Patient Education Handbook 44
Water Fitness
Many of our clients like water programs. You can start
water activities about three weeks after surgery. Water
programs are great, since they are non-weight bearing and
therefore are gentle to painful joints. Water fitness can
improve strength, flexibility, cardiovascular health, decrease
body fat, facilitate rehabilitation after surgery, improve
functional living and even enhance other sports skills. Water
classes today offer more versatility than ever, but how do
you find the right class for your goal, interests, needs and
skills? Find the facility first. Look at your local YMCA,
community center, health club and hospital. Look for a
well maintained pool, adequate locker rooms and life guard
on duty. Hospitals usually offer arthritis or heart-disease
related classes through their physical therapy program
and usually will let you join the class with a prescription
from your Primary Care Physician. Physical-therapy-based
programs are highly recommended for persons with health
issues such as joint or back pain since it is more of a medical
environment and the cost is often covered through health
insurance. Health clubs and the YMCA now also offer most
specialized classes with different fitness levels. Whichever
class you decide to try, start with the lowest level and use the
smallest water weights at first.
Many people make the assumption that because the
exercise is in the water, they cannot injure themselves.
Most importantly, you should feel comfortable in the
environment. If the water is too cold, you find the staff to be
lacking empathy or do not feel at ease in your class, then this
is not the right class for you. Water exercise, like any other
type of exercise, should be done in a relaxing environment.
If this is not the case, it is a sign to look for something else.
Choosing a Personal Trainer
There is a reason movie stars and athletes use personal
trainers: working with a personal trainer is one of the
fastest, easiest, most successful ways to improve your health.
In fact, personal training has proved so effective that it
has spread well beyond the world of the rich and famous.
Today, personal
trainers are
used by people
of all fitness,
social and
economic levels
to help make
lifestyle changes
that they could
not achieve by
themselves.
personal trainer can do:
Consider the
following
things a
Improve your overall fitness. A trainer will monitor and
fine tune your program as you go, helping you work your
way off plateaus. Reach a healthy weight. Remember that
the surgery is only one of the tools to weight loss. Body fat
reduction, weight reduction and management, body shaping
and toning can all be achieved with the aid of a qualified
personal trainer who can help you set realistic goals and
determine strategies, all while providing the encouragement
you need.
Learn to stick to it. Sticking with a well-intentioned
plan is one of the biggest challenges that exercisers face.
Qualified personal trainers can provide motivation for
developing a plan that places a high priority on health and
activity. A trainer can help you brainstorm an agenda to
overcome your biggest obstacles to exercise.
Focus on your unique health concerns. Most personal trainers
are familiar with the special needs of morbid obesity, arthritis
and diabetes. Your trainer can work with your physician,
physical therapist and with Bariatric Program Services to
plan a safe, efficient program that will enable you to reach
your health goals. Find the right way to work out. You will
learn the correct way to use equipment with the appropriate
form and technique for cardiovascular work and freeweight training. Stop wasting time. Get maximum results in
minimum time with a program that is specifically designed
for you. Workouts that use your strengths and improve on
weak points in a way that is efficient and effective. Learn
new skills. Want to learn to skate, golf like a pro or get ready
for an adventure vacation? An individualized program can
improve your overall condition and develop the specific skills
you need. Enhance you mind, body and spirit. A personal
trainer can act as a door to personal growth experiences.
Many personal trainers provide mind-body activities, such as
Tai Chi sessions. Benefit from the buddy system. What could
be better than making a commitment to regularly meet with
someone who will provide you with individualized attention?
Make sure that your trainer has a college degree in the field
of fitness and is certified through a nationally recognized
progam. Ask if the trainer belongs to professional fitness
and exercise associations and regularly attends workshops or
conventions. You can find a personal trainer through your local
health club or community center.
Walking Program After Surgery
For the first thirty (30) days after your surgery, you will
follow the simple plan in your discharge notebook. This plan
is designed to get you slowly, but surely and safely to the
required 30 minutes of aerobic exercise per day by day thirty
following surgery. Remember this 30-minute requirement
is not your long-term goal! You will steadily be
progressing toward the goal of at least
one hour of aerobic exercise each day.
(Aerobic exercise includes but not limited to walking,
recumbent bike, swimming, and arm bike). You must record
your actual after surgery workout program on the log sheets
provided just as you did in the before surgery program
phase. At the end of every week, you will fax, mail, or
otherwise deliver your workout logs to the ES for evaluation.
Remember once you are accustomed to exercise, the
minimum workout should last is 30 minutes. Your long term
goal is one (1) hour. Call or email the Bariatric Exercise
Specialist if you have
any questions about
your exercise program
or exercise in general.
Patient Education Handbook 45
A F T E R S U R G E RY W O R K O U T P R O G R A M
This workout is designed to get you exercising for 30 minutes a day by the 30th day after your surgery.
It is important that you do what is prescribed, although if you are able to do more then by all means
feel free to do so. The important thing is to progress at a good pace. What is listed is the time you are to
exercise, rest period, and the total time it should take for your workout session. For example, Day 1, you
should walk for 5 minutes, rest for 2 minutes, then walk for another 3 minutes with the total time of 10
minutes. Be sure to stretch after each workout.
DAY
WORK
REST
WORK
REST
WORK
TOTAL
DAY 1
5
2
3
10
DAY 2
3
2
3
8
DAY 3
5
2
4
11
DAY 4
5
2
3
10
DAY 5
3
1
3
DAY 6
8
2
5
DAY 7
8
1
3
DAY 8
10
2
5
DAY 9
12
2
3
1
3
11
15
1
3
16
17
1
3
2
3
21
DAY 10
12
2
5
DAY 11
10
2
3
19
DAY 12
15
2
5
22
DAY 13
15
2
5
22
DAY 14
12
2
10
24
DAY 15
15
2
5
DAY 16
15
3
10
28
DAY 17
15
3
15
33
DAY 18
20
3
5
28
DAY 19
20
3
5
28
DAY 20
20
3
10
33
DAY 21
20
3
10
33
DAY 22
20
2
10
32
DAY 23
20
2
5
27
DAY 24
23
1
7
31
DAY 25
25
1
5
31
DAY 26
23
1
7
31
30
2
5
20
29
DAY 27
30
DAY 28
30
DAY 29
30
30
DAY 30
30
30
30
D AY S 1 – 3 0 AFTER S URGERY WOR K OUT LOG
Patient Education Handbook 46
DATE
TOTAL WORKOUT TIME
RPE
DATE
TOTAL WORKOUT TIME
RPE
DATE
TOTAL WORKOUT TIME
RPE
DATE
TOTAL WORKOUT TIME
RPE
DATE
TOTAL WORKOUT TIME
RPE
DATE
TOTAL WORKOUT TIME
RPE
Patient Education Handbook 47
Workout Log
Date
Exercise
Time
Distance
Patient Education Handbook 48
Rate
Perceived
Exertion
Any Physical
Problems
Instructions for Borg Rating of Perceived Exertion (RPE) Scale
While doing physical activity, we want you to rate your perception of exertion. This feeling should reflect how heavy and
strenuous the exercise feels to you, combining all sensations and feelings of physical stress, effort, and fatigue. Try to focus on
your total feeling of exertion, instead of just a certain part of your body.
Look at the rating scale below while you are engaging in an activity; it ranges from 6 to 20, where 6 means “no exertion at all”
and 20 means “maximal exertion.” Choose the number from below that best describes your level of exertion.
6 No exertion at all
7 Extremely light (7.5)
8
9 Very light
9 corresponds to “very light” exercise. For a healthy person, it is like walking slowly at his or
her own pace for some minutes
10
11 Light
12
13 Somewhat hard
13 on the scale is “somewhat hard” exercise, but it still feels OK to continue.
14
15 Hard (heavy)
16
17 Very hard
17 “very hard” is very strenuous. A healthy person can still go on, but he or she really has to
push him- or herself. It feels very heavy, and the person is very tired.
18
19 Extremely hard
19 on the scale is an extremely strenuous exercise level. For most people this is the most
strenuous exercise they have ever experienced.
20 Maximal exertion
Borg RPE scale © Gunnar Borg, 1970, 1985, 1994, 1998
Patient Education Handbook 49
L ong T erm S uccess
FOLLOW-UP PHYSICIAN VISITS
Follow-up appointments are very important and they are
one of the requirements in the “Patient Contract for Success”
that you signed before having your weight loss surgery.
Each patient and their health is an individual matter so
even though regular visits are recommended, the physician
may decide to shorten or lengthen the period between visits
depending on how you are doing. Your physician will tell you
at each visit when you must return.
Follow-up visits for all procedures may be required more
often if you are experiencing any difficulty. Long-term, the
Bariatrician expects to see you once a year. It is probably a
good idea to have your annual physical exam scheduled with
your primary care physician before your annual surgical
appointment. The primary care physician can have testing
done which can then be reviewed with you by your surgeon.
Be sure to have continuous followup with the Dietitian &
Exercise Specialist throughout your journey. This will help
aide in your weight loss success.
Why Follow-up is Important to My Success
Six to twelve months after surgery you may have dropped
the majority of your excess weight while simultaneously
shedding the majority of the medications that you were
taking for weight related health conditions. As a result of
these rapid improvements in your health, you may begin to
think that regular post-op follow-up appointments with our
practice are not necessary considering you are now "healthy."
You may yourself asking "If I'm healthy then why do I need
to see a doctor?" This may lead you to cancel or no-show for
your follow-up appointments with My Bariatric Solutions,
but before you do please read first:
The first doctor’s visit after surgery will be at 1 to 2 weeks
after your surgery. Please keep this scheduled appointment
so that you will not go longer than 2 to 4 weeks for your
first return visit after surgery. This is very important so that
your surgeon can inspect your incisions and discuss your
progress.
Gastric Bypass and Sleeve Gastrectomy patients:
3 months, 6 months, 9 months and 12 months, 18 months,
and every year thereafter for.
LAP-BAND® patients: Your first adjustment will not be until
at least 4 weeks after your surgery date then monthly visits
are highly recommended for the first six months to reach the
right adjustment of the band. Appointments are scheduled as
needed thereafter. We may be calling you to check up on you
and your success if we have not heard from you in 3 months
or more.
Patient Education Handbook 50
Research has clearly shown that weight loss surgery patients
who fail to adhere to the recommended post-op follow-up
schedule are significantly more likely to experience weight
regain and nutrient deficiencies long-term compared to
patients that are compliant with follow-up guidelines. Below
we have outlined for you a list of negative consequences that
can result should you decide not to follow-up and hopefully you will see that regular post-op follow-up visits with
our office are an important part of ensuring that you remain
healthy and fit for life.
Labs
Labs will be drawn at your scheduled appointments for
gastric bypass and gastric sleeve patients, to check blood
levels of B-12, Folate, Calcium, etc. These follow-up labs
are very important to check the status of the availability
of nutrients that your body needs to remain healthy. Labs
may be drawn at other times if you are experiencing certain
problems that make them necessary. Your surgeon and
doctor will determine how often to draw blood based on the
results of your tests.
Expected Weight Loss
Most patients experience a fairly rapid weight loss in the
first 3 to 6 months following surgery. After the first 18
months, it is critical to adhere to the low fat, low sugar diet
and exercise recommendations outlined in this guide to
maintain your weight loss.
Research has shown that weight loss surgery patients who
exercise 3 or more times per week for a minimum of 30
minutes lose an additional 12% of their excess weight in 6
months compared to their cohorts who do not exercise as
strenuously.
Consequence #1 Weight Regain
Research has shown that a high percentage of weight loss
surgery patients regain a significant portion of the weight
that they lose during the first year after surgery. Carnie
Wilson, Darlene Cates (the mother in the 1993 movie
What's Eating Gilbert Grape) and Al Roker are three public
figures that experienced unbelievable early results from
surgery only to regain a significant amount of weight longterm. Researchers have found that weight regain long-term
can be contributed to a number of factors including: not
being prepared for your "new" self, not addressing the
underlying issues that lead to emotional eating before
surgery, and lack of regular physical activity. While weight
regain can and does occur for these reasons after surgery,
you should know that is can be prevented. Our team of
professionals at My Bariatric Solutions is trained to identify
and address any of the factors that may lead to weight regain
long-term; however, it is important to note that we can only
do so if you keep your promise to follow-up with us regularly.
Consequence #2: Multiple Nutrient Deficiencies
Nerve problems, excessive fatigue, excessive hair loss and
bones that break easily are a few of the complications that
can result long-term after surgery due to nutrient deficiencies. The research is clear that weight loss sugery patients
are at a significantly increased risk for long-term deficiencies in folic acid, vitamins B1 and B12, vitamin D, calcium,
protein and iron. The good news is that these nutrient deficiencies are easy to identify and correct before it's too late
by simply complying with your post-op follow-up schedule.
As part of your follow-up program, we carefully screen for
these nutrient deficiencies to ensure these do not occur.
Should you have one, then we immediately place you on the
right nutrient supplements to correct these issues quickly.
If you fail to comply with the follow-up guidelines, then
you may develop a silent nutrient defiency that you may
be unable to feel early on, that that may lead to severe and
irreversible health issues long-term.
Consequence #3: Preventing Others from Getting the Help
That They Need
Morbid obesity is at an all-time high in the United States
with more people looking to weight loss surgery to lose the
weight, reduce and/or eliminate their secondary illnesses
and in extreme caes save their life. As a result of the proven
efficiency of weight loss surgery and thorough follow-up
care, many employers are adding this to the employee's
benefits package. Insurance companies are in turn limiting
where members can have weight loss surgery to select facilities that are proven safe, effective and provide long-term
results. Insurance companies will not continue to allow
this coverage unless they see proven results of long-term
success and ultimately a healthier lifestyle and decrease
in health problems. As a result of our proven successful
track record, most major insurance providers recognize My
Bariatric Solutions as an approved provider. We are very
proud to have such a high success rate but must be able to
maintain it by providing specific data requirements to the
insurance providers. This data is generated from follow-up
visits. Simply put, without the data, we cannot provide the
information to the insurance provider and therefore will no
longer be on the approved list of facilities. This will impact
future friends and family members that could potentially
use our services and lose the weight they so desperately
need.
By now, you should understand the importance of regular
post-surgery follow-up visits. Again, they are in place to
ensure your success and maintain that success.
**special note**
My Bariatric Solutions prefers that you complete your
follow-up visits with our practice as we are trained to
identify and address the potential consequences of weight
loss surgery as outlined above; however, we understand that
this might not be feasible for all of our patients considering
their time constraints and distance from our offices. As
such, should you not be able to see us for follow-up visits
at regular intervals (3,6,9,12, and yearly thereafter post-op)
then we respectfully request that you see a primary care
provider in your area at these timeframes and ensure that
their note is faxed to our office. At your pre-op visit you
were provided with a set of post-op lab orders to cover your
first year post-op. If you are seeing your primary care doctor
Patient Education Handbook 51
vs. us for your long-term follow-up care them please ensure
that you take these lab orders with you and have them draw
these labs as this will ensure that all of your nutrition values
are within normal limits. Again, make sure they fax up these
results along with their notes for your review.
The 8 Rules of Weight Loss
There are eight rules that we have found helpful for weight
loss success. All successful patients have these things in
common:
1. Consumption of an adequate amount of liquid, preferably
water, is crucial. You should consume a minimum of 64
oz. of liquid each day. This can only be done slowly, sipping fluids throughout the day. On very hot or humid
days, or when exercising, you should drink additional
glasses of water. This is necessary in order to prevent dehydration.
2. Only eat at mealtimes. Between meals snacking or “graz-
ing” on small amounts of food throughout the day will
sabotage your weight loss and result in the inability to
lose an adequate amount of
weight.
3. The primary source of
nutrition should be protein.
70 to 75% of all calories
consumed should be protein
based (eggs, fish, meat,
etc). Carbohydrates (bread,
potatoes, etc.) should make
up only 10 to 20%, and fats
(butter, cheese, etc.) only 5 to
15% of the calories that you
eat. A diet consisting of 600
to 800 calories and 75 grams
of protein should be the goal
for the first 6 months.
4. Never drink liquids when
eating solid foods. Liquids should be avoided for a period
of 30 minutes before and 30 minutes after eating meals.
5. Avoid foods and liquids which contain sugar or high
fructose corn syrup. Not only will they slow down your
weight loss, but they may make you sick! Sugar may
cause “dumping syndrome” in patients who have had the
Gastric Bypass procedure. Dumping, in short, is when
sugars go directly from your stomach pouch into the
small intestine causing heart palpitations, nausea, abdominal pain, and diarrhea.
Patient Education Handbook 52
6. Stop eating and drinking when you begin to feel full.
Listen to your body’s signals. Do not look at the food
that is left on your plate. Overfilling your stomach
pouch will cause your pouch to stretch and may prevent
weight loss success – or worse – causing long term
problems and complications.
7. Begin a regular exercise program. This is essential within
the first 4 weeks after surgery. Our research indicates
that this will increase your overall weight loss by 12% in
6 months.
8. Attend support group meetings and workshops. They will
help you stay focused and motivated and help you work
through the changes that weight loss brings. Plus, you
might just make a few new friends.
Changes
As you lose weight, you may notice other changes in your
body. You may experience increased energy levels and you
should be able to sleep better at night. You can anticipate
resuming a more normal life soon after recovery. As your
weight decreases, more physical activity will be possible.
Ongoing exercise will be important for calorie burning,
muscle tone, and a sense of well-being.
Long term, you can anticipate doing things you were not
able to do before. Traveling, eating in restaurants and other
pastimes will be more enjoyable. There may be new career
and social opportunities, and a more positive self-image.
You may notice excess skin folds and wrinkles where the
greatest weight loss has occurred. Reconstructive surgery
to improve your appearance should be delayed until your
weight loss has been stable for one year. We will be glad to
recommend an experienced reconstructive surgeon.
E motional I ssues
Emotional Considerations
Bariatric surgery has both physical and psychological
effects. Please do not take these changes lightly. All patients
need to consider this before and after surgery. Some of
the feelings that you may experience include depression,
frustration, anxiety, anger, disappointment, loss,
helplessness, euphoria, excitement, joy and others. Many
of these feelings have their foundation in physiological
changes. Short term, the immediate sense of loss
of food is often a cause for distress. Along with the
rapid reduction in estrogen levels you may experience
symptoms of depression, not unlike the “baby blues.”
Long term, you may be experiencing changes in body
image and further awareness of the social implications
of obesity.
Bariatric surgery is not a fix for your everyday problems
with your spouse, friends, or family members, employment, or social life. This surgery will allow you to begin to
gain control over one aspect in your life: your weight.
Although you have elected to have weight loss surgery to
resolve your obesity, weight loss also changes the lifestyle
you knew so well. Even with its problems and tensions,
obesity was comfortable, simply because it was known.
Now, that life is gone. When the reality of the new situation
confronts you, it is natural to begin a longing for your old
way of life.
In the past, one of the best methods for you to cope with
life stress may have been for you to eat. This method will
no longer be useful, especially while your new stomach
pouch is at its smallest. One of the keys to success of this
surgery is to learn to replace those comforts with healthy
activities. Replacement methods for coping will need to
be learned, but this will take time. Try not to sabotage
yourself. The experience of such rapid bodily change will
likely be accompanied by many emotional ups and downs,
depending on your age and sex.
There are many things that you can do to help yourself
through the recovery and adjustment period. One of the
most important aspects is the recognition and understanding of the experience of loss. Expect to have ups
and downs as the weeks go by. If you are feeling teary
and depressed, have a good cry. Do not suppress your
emotions. They will surface again anyway. Use the journal
in this guide to get you started. Going for a walk or
adding other physical activities will help you manage this
changing phase of your life.
Adjust your expectations. Set realistic goals and stay
occupied with work, hobbies and exercise. You will also
feel more positive if you look your best. Pay attention to
hygiene, hairstyle, clothes – women may want to experiment with make-up. Take a walk, listen to music, meditate
or pray. Do things you always wanted to do. Enjoy the
process of rediscovery. Talk to your spouse, family doctor,
friends, other patients for support.
We are here to support you through the changes with
personal consultations and support groups. Use the
Journal section in this guide to help you express your
experience. If, at any time, you feel overwhelmed or
otherwise need more assistance, please contact us. We will
be glad to take the necessary steps to refer you to the best
possible resolution.
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Counseling
Family and Friends
Occasionally, personal adjustment or relationship
problems will persist after surgery. These should be
addressed in professional counseling. Emotional
counseling may be needed during the phase of
adjusting to the new physique and the many changes
that follow the surgery for clinically severe obesity.
We can help recommend counselors who are qualified
and experienced in working with people who have had
weight reduction surgery. Do not hesitate to request
this. Major changes can cause new problems to emerge
or old ones to intensify. Our experience has shown
us that in the period of stress, starvation and weight
loss that occurs following surgery, mild to severe
depression is common. You and your support person
You can expect your family and friends to have varying
reactions to your surgical experience and to the weight
loss that follows. Although you hope your loved ones will
be supportive and helpful during your ups and downs,
this may not always be the case. First of all, your partner
or spouse has become adjusted to you and your obesity.
This may result in a resistance to the change, taking the
form of disagreement, mood swings, or refusal to support
your dietary or exercise regimen. Keep communication
channels open, recognize signs of distress in your
partner, who is adjusting to the changes in your body and
behavior. These changes will require your partner to relate
in new ways to you. This takes time, effort and patience.
If you are experiencing serious ongoing problems in your
relationships, some short-term professional counseling
may be helpful.
Body Image
should look for the signs of depression: persistent sad,
anxious or empty mood, loss of interest or pleasure
in activities (including sex), restlessness, irritability
or excessive crying, feelings of guilt, worthlessness,
helplessness, hopelessness, changes in sleep patterns,
decreased energy, fatigue, “feeling slowed down,"
thoughts of death and suicide, difficulty concentrating,
remembering or making decisions – persistent physical
symptoms that do not respond to usual treatment.
Effective drug and psychological treatments are
available.
With treatment, patients can improve and return
to normal quickly. Unfortunately, most depressed
persons do not recognize their depression. You and
your support person need to be aware of the risks
of depression in the recovery period and if present,
we need to discuss possible treatment. Professional
counseling can be a positive step toward a healthier
adjustment.
Patient Education Handbook 54
Keep in mind that as your body undergoes changes in
weight and size, it is likely you may not see your body as
others may view it. It takes time for your mind to catch up
with what your body is doing. It is similar to the phantom
limb phenomenon, where a person who has lost a limb
continues to experience pain or feeling from the missing
part, and in fact, feels they still have a limb. As you lose
weight, you may actually be surprised when you see your
reflection in a store window or mirror. You may not feel like
this person is you! It is normal to feel like you are still the
same size as you were before, but there are some definite
ways to help you work at this.
Here are some examples:
Take a picture of yourself every few weeks during your
weight loss and compare the changes. Try on clothes in a
smaller size. You’ll be surprised how quickly you will be
changing sizes. Have someone point out a person in a public
place who is about the same size as you. This helps you have
a new frame for reference. Take measurements of yourself
every few weeks and record the results. Save an outfit from
your pre-op size and try it on every few weeks or whenever
you need a lift. Accept compliments graciously. Don’t
minimize or qualify your weight loss.
When you signed the Patient Contract for Success you
agreed to attend 1 monthly support group meeting. All
support groups are held on the 2nd Tuesday of each
month at 6:30 –7:30 online. Check the schedule for the
meeting location and topics at MyBariatricSolutions.com
Support Group Meetings
We consider group meetings to be mandatory. We know
realistically we cannot make you attend these meetings,
but they are for you: for education, support, nutritional
and medical advice. Group meetings provide peer support,
allow you to learn about the surgery firsthand from
others who have had bariatric surgery, let you share your
experiences and provide periodic guest speakers to expand
your knowledge on obesity surgery-related topics. They
are great for problem solving. These support groups are a
wonderful opportunity to make new friends and be with
people who share what you are experiencing. It can be
reassuring to hear other’s viewpoints on common concerns
and to get additional information from the group leader or
guest speaker. Research has shown that patients who attend
support groups regularly are more successful with their
weight loss and mental adjustment than people who do not,
especially long term. You will find these meetings helpful in
many ways. Family and friends are always welcome to attend.
Note: Every person attending a support group is to sign a
confidentiality agreement. We are very interested in your
feedback to better serve your needs. Suggestions forms will
be provided at all support group meetings.
Patient Education Handbook 55
J ournal
We strongly recommend that you start a journal to
accompany you through your journey. Along with pictures,
measurements and milestones, the journal will help you put
into words the changes that you are going through. You will
treasure this work and will be glad to flip back the pages
to see your transformation. To get you started, we have
given you a few exercises for you to complete. This is your
journal; nobody is going to ask you to share it with anyone,
unless you want to do so. Be truthful and honest with
yourself and have fun writing down on paper the struggles,
surprises and the accomplishments (and don’t forget to date
it).
Date_______________________
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