Download Patient Education Booklet - Physicians East Surgical Weight Loss

WELCOME!
Thank you for your interest in Physicians East Bariatrics. We feel very honored that you
are considering becoming a partner with us in your weight loss journey. Our goal is to
assist you in being successful in overcoming your disease of obesity.
Our mission is to use a team of skilled health care professionals to meet the challenge of
delivering quality, cost-efficient, comprehensive health care to our patients. We are
committed to helping individuals improve and maintain their health by providing
compassionate, state-of-the-art care. We hold sacred the physician-patient relationship
and will endeavor to preserve and protect this mutual trust.
This Education Book has been designed to assist you in learning more about our Bariatric
program. It provides you with the needed information to help you to determine if having
Bariatric surgery is the right option for you.
It is very important that you read this book and understand the information that it
contains. We encourage you to share this information with your family and support
persons that will be a part of your weight loss journey.
If you have any questions or concerns that arise during your journey with Physicians East
Bariatrics, please feel free to contact us. Our contact information is listed below. We are
looking forward to working with you.
Contact Information:
Physicians East Bariatrics
1850 West Arlington Blvd.
Greenville, NC 27834
Phone: 252-413-6398
Website: www.physicianseast.com
Surgeons: Dr. Kenneth G. MacDonald
Dr. Tim McGuire
Bariatric Program Coordinator: Bobbie Lou Price, RN, BSN, CBN
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Your Bariatric Multi-Disciplinary Team
At Physicians East Bariatrics, our program brings together dedicated professionals that
are committed to your care through every step of your weight loss journey, both before
and after your surgery. All of our team is dedicated to assure that you are successful in
using your tool of bariatric surgery.
Our Multi-Disciplinary Team includes:
-Surgeon
-Certified Bariatric Nurse
-Surgical Technician
-Cardiologist
-Pulmonologists
-Nutritionists
-Psychologists
-Radiologists
-Laboratory Technicians
-Endoscopy Center Staff
-Anesthesiologist
-Hospital Staff
-Office Staff
Special Features of Physicians East Bariatrics:
-Board Certified Surgeons who has specialized in the field of Bariatric surgery for over
25 years with experience in both open and laparoscopic procedures.
-A Certified Bariatric Nurse who has practiced in the field of Bariatric Surgery for over
15 years.
-Education Classes that are offered weekly.
-Support Groups that are offered once a month.
-A facility that offers the services of Pulmonary, Endoscopy, Laboratory, Radiology and
Nutrition in one area for more time efficient care. Cardiology and Psychology serves are
offered in near by medical offices.
-Medical Park Pharmacy that offers easily assessable bariatric supplies such as protein
supplements, vitamins and other resources adjacent to the Physicians East Bariatrics
building.
Physicians East Bariatrics is affiliated with Pitt County Memorial Hospital and the
SurgiCenter, which are parts of University Health Systems in Greenville. You may have
your surgery at either facility depending on the type of surgery and insurance
requirements. Pitt County Memorial Hospital has served as pioneers in the world of
bariatrics for nearly 30 years. Both facilities have received their Centers of Excellence
certification for bariatrics with the Surgical Review Corporation.
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Information Regarding Obesity
Obesity is a serious and rising health epidemic in our country. You are not alone in this
fight. It is estimated that nearly 93 million Americans are obese and that number is
predicted to climb to 120 million within the next five years.
A person is classified as morbidly obese when their Body Mass (BMI) is greater than 40,
or they are more than 100 pounds over their ideal body weight. Additionally, individuals
who have a BMI of 35 or greater with an existing co-morbidity (i.e. diabetes,
hypertension, etc.) are also classified as morbidly obese.
Morbid obesity is most commonly calculated using BMI. BMI is a measurement used to
indicate obesity and morbid obesity in adults. BMI is calculated by dividing a person's
weight in kilograms by his or her height in meters squared. An adult with a BMI of 40 or
greater is considered obese. Additionally, an individual is considered morbidly obese
with a BMI of 35 or greater, with an existing co-morbidity.
Many obesity-related conditions accompany morbid obesity. Once an individual is
considered morbidly obese, these conditions become serious health risks. These obesityrelated conditions also negatively impact the quality of life for individuals and their
family members affected by morbid obesity. The most common morbid obesity-related
diseases include:
-High Blood Pressure
-High cholesterol
-Diabetes
-Heart disease
-Stroke
-Gallbladder disease
-Osteoarthritis
-Sleep apnea and respiratory problems
-Some cancers (endometrial, breast, and colon)
Reference:
Obesity Action Coalition, www.obesityaction.org
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Calculating your Ideal Body Weight and Body Mass Index (BMI)
If you are 100 pounds or more above your ideal weight for your height then you are
considered as morbidly obese. In order to calculate your ideal body weight, we use the
middle of the medium frame size noted in the Metropolitan Life Insurance Company
tables. They are provided for you below.
WOMEN
(Weight in Pounds)(In Indoor Clothing)*
HEIGHT
(In Shoes)+
Feet Inches
4
4
5
5
5
5
5
5
5
5
5
5
5
5
6
SMALL
FRAME
MEDIUM
FRAME
10
102-111
109-121
11
103-113
111-123
0
104-115
113-126
1
106-118
115-129
2
108-121
118-132
3
111-124
121-135
4
114-127
124-138
5
117-130
127-141
6
120-133
130-144
7
123-136
133-147
8
126-139
136-150
9
129-142
139-153
10
132-145
142-156
11
135-148
145-159
0
138-151
148-162
Indoor clothing weighing 5 pounds for men and 3 pounds for women.
LARGE
FRAME
118-131
120-134
122-137
125-140
128-143
131-147
134-151
137-155
140-159
143-163
146-167
149-170
152-173
155-176
158-179
MEN
(Weight in Pounds) (In Indoor Clothing)*
HEIGHT
(In Shoes)+
Feet Inches
5
5
5
5
5
5
5
5
5
5
6
6
6
6
6
SMALL
FRAME
MEDIUM
FRAME
2
128-134
131-141
3
130-136
133-143
4
132-138
135-145
5
134-140
137-148
6
136-142
139-151
7
138-145
142-154
8
140-148
145-157
9
142-151
148-160
10
144-154
151-163
11
146-157
154-166
0
149-160
157-170
1
152-164
160-174
2
155-168
164-178
3
158-172
167-182
4
162-176
171-187
Indoor clothing weighing 5 pounds for men and 3 pounds for women.
Updated 7/2011
LARGE
FRAME
138-150
140-153
142-156
144-160
146-164
149-168
152-172
155-176
158-180
161-184
164-188
168-192
172-197
176-202
181-207
4
Reference: www.halls.md/ideal-weight/met.htm
For example, if a patient is female and is 5’3” tall, we would say that her normal weight
as the midpoint of 121-135 pounds. This would be 128 pounds. This person would have
to weigh about 228 pounds to be considered morbidly obese.
Determining Your Body Mass Index (BMI): The table below has already done the
math and metric conversions. To use the table, find the appropriate height in the left-hand
column. Move across the row to the given weight. The number at the top of the column is
the BMI for that height and weight.
BMI
(kg/m2)
Height
(in.)
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
19
20
21
22
91
94
97
100
104
107
110
114
118
121
125
128
132
136
140
144
148
152
156
96
99
102
106
109
113
116
120
124
127
131
135
139
143
147
151
155
160
164
100
104
107
111
115
118
122
126
130
134
138
142
146
150
154
159
163
168
172
105
109
112
116
120
124
128
132
136
140
144
149
153
157
162
166
171
176
180
Category
23
25
26
27
28
29
30
35
40
Weight (lb.)
110 115 119
114 119 124
118 123 128
122 127 132
126 131 136
130 135 141
134 140 145
138 144 150
142 148 155
146 153 159
151 158 164
155 162 169
160 167 174
165 172 179
169 177 184
174 182 189
179 186 194
184 192 200
189 197 205
124
128
133
137
142
146
151
156
161
166
171
176
181
186
191
197
202
208
213
129
133
138
143
147
152
157
162
167
172
177
182
188
193
199
204
210
216
221
134
138
143
148
153
158
163
168
173
178
184
189
195
200
206
212
218
224
230
138
143
148
153
158
163
169
174
179
185
190
196
202
208
213
219
225
232
238
143
148
153
158
164
169
174
180
186
191
197
203
207
215
221
227
233
240
246
167
173
179
185
191
197
204
210
216
223
230
236
243
250
258
265
272
279
287
191
198
204
211
218
225
232
240
247
255
262
270
278
286
294
302
311
319
328
BMI range kg/m2
Starvation
less than 14.9
Underweight
from 15 to 18.4
Normal
from 18.5 to 22.9
Overweight
from 23 to 27.5
Obese
from 27.6 to 40
Morbidly
greater than 40
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5
Obese
Reference: www.nhibi.nih.gov/guidelines/obesity/bmitbl.htm
Types of Bariatric Procedures Offered
Physicians East Bariatrics offers three different types of bariatric procedures for our
patients. Your surgeon will assist you in choosing which surgery type would be best for
you.
Gastric Bypass
This procedure, the Roux-En-Y gastric bypass, involves placing three rows of staples
near the top part of the stomach. This forms a small pouch that will hold less than 30cc
of food or liquid (about 1 ounce). The remainder of the stomach is not removed, but
excluded from the pouch. A portion of the small intestines is attached to the pouch with a
small opening. This is called an anastomosis. This opening is the size of the eraser on a
pencil. By doing this, food is unable to pass through the larger part of the stomach. It is
also unable to pass through the first part of the small intestine. This operation helps with
weight loss because it decreases the amount of food that is eaten. A person feels full
when eating a small amount of food. It also makes a person feel full longer after a meal.
This is because the small hole created prevents food from leaving the pouch too fast. This
type of procedure helps you to lose weight by malabsorption of your foods and calories
and by restriction, allowing you to only eat small amounts of foods at one time.
The Dumping Syndrome can occur when you attempt to eat foods or liquids with glucose
or sugar in them. These include foods like breads, pasta and sweets. Your body is trying
to get rid of the high sugar load that has rapidly passed through your small stomach
pouch. Sweets and refined sugars should be avoided in your daily diet and breads and
pasta should be eaten in moderation. The symptoms that you may have are:
Rapid Heart Beat
Dizziness
Sleepiness
Nausea
Stomach Cramping
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Sweating
Lightheadedness
Headache
Diarrhea
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These symptoms may occur in any combination. They many be severe, but should go
away on their own. The Dumping Syndrome will only occur after with the gastric
bypass.
Sleeve Gastrectomy
The Sleeve Gastrectomy is a restrictive procedure, which limits the amount of food you
can eat by reducing the size of your stomach. During this procedure, a thin vertical
sleeve of stomach is created using a stapling device. This sleeve will typically hold
between 50 to 150 ML, or is about the size of a banana. The excised portion of the
stomach is removed. The nerves to the stomach and the outlet valve remain intact with
the idea of preserving the functions of the stomach while drastically reducing the volume
without bypassing the intestines or causing any malabsorption.
Gastric Band
The Gastric Band is a silicone ring designed to be place around the upper part of the
stomach and filled with saline on the inner surface. This creates a new small stomach
pouch and leaves the larger part of the stomach below the band so the food storage area
in the stomach is reduced and the pouch above the band can hold only a small amount of
food. The band also controls the stomach outlet between the two parts of the stomach.
The size of the stoma regulates the flow of the food from the upper to the lower part of
the stomach. When the stoma is smaller, you feel full sooner. This type of procedure
helps you to lose weight by restricting the amounts of foods and liquids that you can
consume at one meal.
The band is connected by tubing to an access port that is placed beneath the skin during
surgery. Later, the surgeon can change the stoma size by adding or subtracting saline
inside the inner balloon through the access port. This process helps the rate of weight
loss. This surgery can be done through the open or laparoscopic approach. This will be
determined by your surgeon
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The Gastric Band can be removed if there is a problem with the band, or if you cannot
lose enough weight or adjust to the new eating habits. This decision will come after your
surgeon has consulted with you. Please keep in mind that when the band is removed,
your weight will likely increase.
Our programs offers
placement of the
Realize® Band that is produced by Ethicon EndoSurgery and the LAP BAND® that is
produced by Allergan. For more information about the two band products on the market,
please visit their website at:
www.lapband.com
OR
www.REALIZEband.com
Revisions
If you have had any other type of bariatric surgery and you are seeing us for a
consultation, please bring a copy of your operative note, discharge summary and any
other reports with you to your appointment.
Complications Related to Bariatric Surgery
All Bariatric procedures, whether open or laparoscopic should be considered as a major
operation. Every precaution is taken during surgery to prevent any complications.
However, the chance of these happening cannot be taken away. The following is a list of
complications that may occur following surgery. This list is a review of the common
things that may occur following surgery, it is not an inclusive listing. Please discuss this
list with your surgeon for a more detailed explanation.
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Gastric Bypass
Early complications (may occur within the first 30 days after surgery)
Death
Spleen injury
Pneumonia
Bowel Obstruction
Abdominal Infection
Bleeding
Heart Attack
Anastomotic Narrowing
Leak from the bowel
Pulmonary Embolus (blood clot)
Wound Infection
Nausea/Vomiting
Late complications (may occur after the first 30 days after surgery)
Incisional Hernia
Weight Gain
Bowel Obstruction
Ulcers at the Anastomosis
Nutritional Problems
Excessive Weight Loss
Hair Loss
Depression
Staple Line Breakdown
Gallstones
Sleeve Gastrectomy
Separation of stapled tissue
Gastric leakage
Dyspepsia
Death
Bowel Obstruction
Stomach Stricture
Reflux
Leak from staple line
Ulcers
Esophageal dysmotility
Bleeding
Pulmonary Embolus (blood clot)
Vitamin B12 deficiency
Iron Deficiency
Gastric Band
Band/Stomach or port slippage
Band erosion
Port Infection
Pulmonary Embolus (blood clot)
Bleeding
Death
Weight Re-Gain
Reflux
Ulceration at the Band
Esophagus dilation or stretching
Leakage from the device
Wound Infection
Pneumonia
Stomach/Esophageal Injury
Poor Weight Loss
Surgical Techniques Used to Perform Bariatric Surgery
There are two types of surgical techniques used to perform Bariatric surgery. It can
either be done through an open or laparoscopic approach.
The open approach is done by making an incision from below the breastbone to several
Updated 7/2011
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inches above the belly button. This gives the surgeon enough room to be able to the
surgery safely. It also allows the surgeon to see the areas of the stomach needed to do the
operation.
The laparoscopic approach is different because of the type of incision that is used. The
surgeon will make six small incisions instead of one long one. Long instruments are
inserted into each incision. With the aid of a camera and television screen, the surgery is
performed. This surgery may not be ideal for every patient because of his or her size,
weight, size of the patient’s liver and past abdominal operations.
General Considerations for Weight Loss Surgery
To be considered a candidate for Gastric Bypass and Sleeve Gastrectomy you need
to:




Be 100 pounds above your ideal body weight
Have a body mass index of greater than 35 with health complications or 40 or
greater with or without health complications
Have been overweight for more than 5 years
Be between the ages of 18 and 69 (anyone younger or older will be reviewed on
an individual basis by their surgeon)
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0






Have documented failed attempts at weight loss in the past
Have no psychological contraindications, if you have a diagnosis of
schizophrenia, you will not be considered a candidate.
Be able to understand the surgery and its risks
Be able to comply with the dietary and exercise requirements
Be willing to continue to be monitored by your surgeon
Be willing to make necessary lifestyle changes to help your tool work effectively
To be considered for the Gastric Band you need to:











Be at least 18 year old
Have a body mass index of greater than 35 with health complications or 40 or
greater with or without health complications
Have a body mass index between 30 to 35 with a health complication, only
available for the LAP-BAND®, insurance may not cover
BMI must be equal or less than 50
Be 100 pounds above your ideal body weight
Have been overweight for more than 5 years
Have had failed attempts at weight loss in the past
Not be suffering from any other disease that may have caused your obesity
Be prepared to make substantial changes in your eating habits and lifestyle
Be willing to continue to be monitored by your surgeon
Be willing to have your band adjusted
*Please note that your insurance company may have additional requirements as
well.
You cannot be considered for Bariatric Surgery if you:












Have an inflammatory disease or condition of the GI tract such as ulcers, severe
esophagitis or Crohn’s disease
Have severe heart or lung disease that makes you a poor candidate for surgery
Have some other disease that makes you a poor candidate for surgery
Have a problem that could cause bleeding in the esophagus or stomach, this may
include esophageal or gastric varices
Have portal hypertension
Have a congenital or acquired problem with your esophagus, stomach or intestine
Have or have had a surgical injury to your stomach where the band will be placed
Have cirrhosis
Have chronic pancreatitis
Are pregnant
Might be allergic to materials in the band
Are on chronic, long-term steroid treatment
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1

Have an autoimmune connective tissue disease such as lupus or scleroderma
Referral to Physicians East Bariatrics
Referrals can happen in one of two ways:
Self-Referral: You as a patient may call our office at 252-413-6398 and refer yourself to
be scheduled for an Education Class.
Doctor Referral: Your doctor may also refer you. This type of referral is most helpful
if your insurance carrier requires for you to have an authorization to see a surgeon who
specializes in the surgical treatment of obesity.
Once your have been referred to our office you will be given an appointment to attend a
Patient Education Class. You will be mailed a questionnaire and other paperwork to fill
out and bring with you completed to the class. Once completing the Education Class, the
pre-operative evaluation appointments that you will need will be scheduled.
You will need to contact your insurance company to make sure that bariatric surgery is a
covered benefit under your policy and that there is not an exclusion. When calling your
insurance company you may ask “I am considering having an surgical procedure weight
loss (state name of procedure) whose CPT code (is state code). Is this procedure an
exclusion of my group policy?”
Gastric Bypass (Roux-en-Y)
43644
Adjustable Gastric Banding
43770
Sleeve Gastrectomy
43775
If there is an exclusion, then surgery for obesity is not, nor can it become a covered
benefit. It will also not pay for any tests or clinic visits pertaining to the surgery. Your
only option at this point would be to self-pay for the surgery.
It is very important that you bring your insurance card with you to the Patient Education
Class. A copy will be made and put into your chart for future reference during your care
with our practice. If your insurance information changes at any point during your care,
please let our office staff know immediately.
You will need to stop smoking for 3 months prior to your surgery and remain smoke free
following surgery. This is a lifetime commitment. It is best to try and stop smoking now
during your pre-operative evaluation work up. This helps your lungs to function at the
best level that they can and it also aides in the healing process following surgery.
Evaluation Testing
These are tests that will be needed for the insurance approval process and to better
prepare you for surgery. Your surgeon will decide which of these tests you will need.
The amount of tests that are ordered will vary depending on the type of insurance and
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health condition of each patient.
The tests may include, but are not limited to:
Lab Work
Anesthesia Consult
Ultrasound of the Gallbladder
Vascular Consult
Nutrition Evaluation
Any other tests deemed necessary by your
surgeon
Psychological Consult
5 year weight history
Endoscopy
3 or 6 month diet and exercise program
Pulmonary Consult
Cardiology Consult
*Some of our patients will need to be seen by the anesthesia department before their
surgery. This will be done if you weigh more than 350 pounds or if your insurance
company requires that this be done as part of your evaluation testing. During this
visit, an anesthesiologist will talk with you about the risks of being put to sleep during
your surgery.
History and Physical/Pre-Operative Appointment (Meeting with the Surgeon)
After receiving all of the results from your evaluation tests in our office, they will be
reviewed by your surgeon. If you are a candidate for surgery, our office will contact the
insurance company to obtain approval. We will send them the information needed to get
prior approval for your surgery. This can take 2 to 4 weeks to receive this. Once your
approval for surgery has been received, our office will call you with an appointment date
for your History and Physical. You will also get a date for your surgery. If your
insurance carrier denies you, there are two options:
 Self pay for the surgery
 Appeal the decision
Although you may be an ideal candidate medically, you still may not get insurance
approval. The Obesity Action Coalition has provided patients with a guide that can
assist you in working with your insurance provider. You can obtain access to this by
going to their website at www.obesityaction.org/educationaltools/brochuresand
guides.php
This guide is titled OAC Insurance Guide and is located at the bottom of the webpage.
Your appointment will be made once all of your pre-operative evaluation appointments
have been completed and you have met all of your insurance requirements for surgery.
You will meet with your surgeon. A physical exam will be performed and you will also
be asked questions about your family, medical and surgical history. Please bring all of
the medications that you are currently taking with you to this appointment. Your surgeon
will also talk with you about your surgery and answer any questions that you may have.
You will have to sign 3 consent forms. One gives your surgeon permission to operate on
you. The second one gives permission to use blood or blood products during your
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operation if necessary. The third one verifies that you understand all of the information
that has been reviewed and given to you during your pre-operative workup.
One important thing to remember is that you MUST bring your spouse if you are married
and if not the support person that will be with you after surgery to this appointment. This
is so the surgeon can talk with them about your surgery. If this is not done then your
surgery will be canceled. This is a requirement of the program.
After your clinic visit is complete, you will be given a packet of information. You will
need to take this to the Patient Testing Center. The Surgery Scheduler will give you
directions. At the Center, you will be checked in and a nurse will review your
paperwork. All necessary tests will be performed such as lab work, EKG and chest x-ray.
You will be given a phone number to call the day prior to surgery to see what time you
will need to arrive at the hospital the morning of surgery.
Once you have been given a surgery date, these are some things that you will need to
consider:
 Two weeks prior to your surgery stop taking all Aspirin, Motrin, Ibuprofen,
Naproxen, Advil, Vitamin E, and other arthritis/pain medications other than
Tylenol. These medications can increase your risk of bleeding, inhibit the clotting
mechanism and increase your chances of unnecessary bleeding during your
surgery. You should also avoid these medications following surgery.

If you have any significant facial hair, you must shave prior to surgery. Please
remove all finger nail and toenail polish, as well as false fingernails prior to
surgery. All of these things help the anesthesiologist to better care for your
respiratory needs during and after surgery by being able to securely place a
facemask on your face and to be able to see your nail beds for any discoloration.

You will be expected to lose some weight two weeks prior to your surgery. You
and your surgeon will determine the amount of weight loss that is right for you.
We will provide you with the diet that you will need to use during this time.

Be sure any medications you are taking have been converted to a liquid, crushable
or chewable form by the doctor that prescribed them for you.

If you have sleep apnea, please bring your CPAP/BiPap machine with you to the
hospital on your day of surgery.
Day of Surgery
You will come in to the hospital or outpatient facility the morning of your surgery. You
should not have eaten or drank anything after midnight on the day of your surgery. Do
not eat any heavy meals on the day prior to your surgery.
After you have checked in, the nurse will place you in a bed and have you put on a
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4
hospital gown. An IV will be inserted into a vein in your arm. This is needed for fluids
and medications to be given prior to, during and after surgery.
After the nurse has prepared you for surgery, you will then be taken to the holding area.
This is where you will stay until it is time for your surgery. The person who will be
giving you the anesthesia to make you sleep during surgery will stop by to see you. They
will explain the procedure and ask if you have any additional questions.
Recovery
After your surgery, you will spend several hours in the recovery room. You will stay
there until you are fully awake. When you wake up you will have several tubes and
machines attached to you. These may include, an IV, a catheter in your bladder, drainage
tubes inserted into your stomach, a pulse oximeter that will be on your finger, EKG
monitor pads on your chest and oxygen tubing in your nose. Several hours after your
surgery you will be assisted to sit up on the side of the bed. If you had the Gastric Band
surgery, if no complications arise you will be discharged the same day as or the morning
after your surgery. If you had the open gastric bypass or sleeve gastrectomy your
hospital stay will last for 3 to 4 days and laparoscopically for 2 to 3 days. With the
gastric bypass and sleeve gastrectomy on the first day following surgery you will be
assisted to sit in a chair and walk as much as possible while in the hospital. Gastric Band
patients will continue to do this at home with assistance. You may be out of work with
the Gastric Band and laparoscopic gastric bypass and sleeve gastrectomy for 2 to 4 weeks
following surgery and the open gastric bypass and sleeve gastrectomy for 4 to 6 weeks.
You will not be able to drive for 2 weeks following surgery. Do not lift anything over 10
pounds for 4 weeks following surgery.
General Requirements Following Surgery
Follow up appointments:
Having proper follow-up after your surgery is very important. For the first month after
your surgery, you will be seen every two weeks. You will be seen every three months for
the first year. You will then be seen every six months or yearly for a lifetime. During
these visits your doctor or nurse will see you. Lab work will be drawn to make sure that
you are as healthy as possible starting at your 1-month post-operative visit. You will also
need to continue to see a family doctor for any health problems not associated with your
operation.
You will be required to see our Nutritionist and Psychologist during the first month
following your surgery. These appointments are important in helping you to adjust to
your lifestyle following surgery.
Vitamins/Medications:
Vitamins and minerals perform specific and individual functions in your body, as well as
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helping to maintain the function of cells. Problems can occur if you do not get the proper
amount daily.
Once you are discharged from the hospital you will start taking multivitamins, vitamin
B12, Iron and Calcium if you had the Gastric Bypass or Gastric Sleeve. Gastric Band
patients will only need to take multivitamins and Calcium. You will have to take these
for a lifetime.
All of your medications following surgery should be crushed, chewable or in a liquid
form. This rule will need to be followed for the first 6 month to a year, after which time
you can cut your pills into small portions (no larger than a pencil eraser). Please be sure
to contact your prescribing physician regarding all of the medications you are taking to
make sure they can be converted into one of these appropriate forms.
Medications to avoid after surgery:
 Ibuprofen
 Advil
 Motrin
 Aleve
 BC Powders
 Goody Powders
 Aspirin
 Non-Steroidal Anti-Inflammatory
If you must take these medications, please do so for a very short period of time and ask
the prescribing physician to prescribe a proton pump inhibitor to accompany one of the
medications above.
Diet
While you are in the hospital your diet will consist of 2 ounces (60cc) of a protein
supplement for each meal (three times a day) and 1 to 2 ounces (30 to 60cc) of water
every hour in between meals.
When it is time for you to go home, your diet will advance in stages. With the Gastric
Bypass and Sleeve Gastrectomy you will begin with liquids only, then advance to pureed
foods and liquids, then to soft foods and meats. With the Gastric Band, you will begin
with pureed foods and liquids, then advance to soft foods and meats. You must sip water
slowly throughout the day to help prevent dehydration. You will be required to obtain 60
to 80 grams of protein within your daily diet. You will be given instructions on how to
advance your diet from your surgeon and the office staff. When you have your nutrition
consult, you will be given your post-operative diet along with additional teaching.
Gastric Band Adjustments
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The first time that your band will be adjusted is usually 4 to 6 weeks after your surgery.
You and your surgeon will decide when the right time is for you.
To adjust your band, the clinician injects saline into the port that is located just under
your skin. The band can also be adjusted by removing saline from the port. This is done
with a special fine needle. You may feel a pricking sensation when this is done.
Adjustments are done either in radiology or in the surgeon’s office. The surgeon may
need x-ray to help him in locating the port. You may need more than one adjustment.
During each adjustment, only a very small amount of saline will be added to or removed
from the band. The exact amount of fluid required to make the stoma the right size varies
from person to person.
Some insurance companies will not cover adjustments, so you will need to check with
your company in regards to coverage.
Support Group
This group gives you an opportunity to learn more about our program and more about
bariatric surgery before and after surgery. It gives you an opportunity to talk with other
patients who are awaiting surgery or who have already had surgery. This group is open
to you and to your family and support system. While attending is not mandatory, it is
highly recommended, as it will aid you in your journey both before and after surgery.
Exercise
A good exercise program is vital in order for you to have adequate weight loss. You will
have to start exercising slowly. Increase the amount that you do each day. Good forms
of exercise are bike riding, walking, swimming, jogging, aerobics and weight lifting or
training. You should set a goal to exercise 5 to 7 days a week for 30 to 45 minutes daily.
After your surgery, you will be given a free 3-month trial membership with ViQuest.
Pregnancy
We believe that becoming pregnant is safe, after a stable post-operative weight has been
reached. This is usually 12 to 18 months after your surgery. Some patients have become
pregnant within this time frame. Although they have had healthy children, we
STRONGLY advise AGAINST getting pregnant during this period. There could be
nutritional problems and negative effects on the baby as it develops. We STRONGLY
recommend the use of birth control during this 12 to 18 months period.
Plastic Surgery
If you feel the need to have any plastic surgery after your weight loss surgery, we
recommend that you wait at least 2 years after your surgery before having any plastic
surgery. You want to be sure you have maintained your stable postoperative weight.
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Weight Loss Following Bariatric Surgery
Gastric Bypass
Most patients who have the gastric bypass will lose around 62% of their excess body
weight. Generally, weight loss will level off around the 2-year period after your surgery.
Sleeve Gastrectomy
Most patients who have the sleeve gastrectomy will lose around 55% of their excess body
weight.
Gastric Band
Most patients who have had the gastric band will lose around 48% of their excess body
weight. With the Gastric Band, you should lose weight gradually.
The amount of weight loss varies from patient to patient. You may not reach your ideal
body weight, but your weight loss will be enough to make you see a difference.
Your best chance for weight loss with both surgeries is to follow the diet and
exercise programs recommended to you by your surgeon.
Conclusion
Bariatric surgery is a major step for people suffering from morbid obesity. It is a right
choice for some people, but not right for others. The only way to be sure that this
decision is right for you is to completely understand what the surgery involves. You
should also know the risks and benefits of this surgery.
This guide was designed to help you understand more about the choices of bariatric
surgery that is offered through Physicians East Bariatrics. Now that you have read all of
the information you should discuss this with your surgeon and the staff. Please share any
questions or concerns that you may have. Our goal is to help you make the right decision
for your weight loss journey.
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