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Bariatric Surgery FAQ’s

How do I setup a consult with one of the physicians?

You first need to fill out completely all our forms and mail them to our office. Once all the forms are received in their entirety, we will call you to setup your appointment. Please use blue or black ink only – no pencil.

How soon can I get this consultation?

There are 4 doctors currently in this practice which also do other surgeries as well as Bariatric surgery. After your paperwork is received in our office, an appointment will be scheduled on a first available basis.

After I have my consultation, what happens next?

After the doctor has determined that you are a candidate for the surgery and you agree that this surgery is what you want, then a predetermination is filed with your insurance company. This predetermination process could take 4 to 6 weeks. After the approval letter is received in our office, the surgery can usually be scheduled within 3 to 4 weeks.

What happens to the bypassed stomach?

The stomach and entire GI tract do not receive their nutrients directly from the food we eat. Instead, that food is digested, absorbed through the intestine, and broken down to it’s constituent parts in the liver. Those nutrients plus oxygen are then delivered back to the cells of the bypassed stomach and rest of the tissues via their blood vessels. The gastric bypass leaves the blood supply to the stomach intact, thus the bypassed stomach remains a living organ, just one that cannot receive directly into it any food we eat.

How do I stop losing weight?

To answer this we must remember that weight loss comes about by consuming less calories than we burn. Immediately after the gastric bypass, the newly created gastric pouch is small, somewhat swollen and thickened because of it’s recent surgery, and it is not very distensible. It won’t hold very much. A patient’s caloric intake is drastically reduced – perhaps 400 calories / day! As time passes, though, the degree of inflammation of the stomach decreases and it’s walls become more pliable. Since it can stretch a bit more, the stomach can hold more, and caloric intake increases. In fact, the amount one is able to eat may roughly triple over the course of a year (Although that is still much less than what the non-operated stomach can hold.) More calories consumed means less weight loss. Additionally, as a patient loses weight, the amount of energy required to move around and support those tissues decreases. For example, imagine you are walking around your local home improvement warehouse store with two 40 pound bags of fertilizer in your arms. You would notice a big difference in the amount of energy you are using when you finally set those bags down and walk around without them. At some point, usually between 12-24 months after surgery, the amount of calories consumed per day will approximate the amount of calories burned per day and you weight will plateau. If a patient is unable to keep food down, however, that may be indicative of a problem, and that patient should call his or her surgeon.

What are good protein sources and calcium sources?

Protein: All meats (beef, chicken, pork), fish, eggs. Try to choose leaner cuts and avoid fried foods as they have extra calories. Lean, thin sliced luncheon meats such as turkey or even ham cut into small pieces work well. As with all foods, remember to cut the food into very small pieces, eat only one small piece at a time, chew very well, and eat very slowly.
Calcium: Skim milk, sugar free / fat free yogurt, cheese (although cheese can be high in fat and calories). Despite consuming foods rich in calcium, all gastric bypass patients should also take calcium in the form of a calcium plus vitamin D supplement to equal or exceed 1000-1200mg/day of supplemental calcium.

Why do I need to take calcium?

Calcium is a very important supplement for gastric bypass patients as the portion of the GI tract which is most active in the absorption of calcium is partially bypassed. Calcium is necessary for bone strength, and without it bones can become weak and brittle, a disease called, osteoporosis. It is slow to develop, has no early symptoms, and is difficult to treat if present. This is a definite example of “an ounce of prevention is worth a pound of cure!”

What type of vitamin and calcium supplement should I take?

Contrary to popular belief, our gastric bypass patients are not required to take their supplements as a chewable tablet or liquid – although many patients prefer to do it this way. The vitamin should be a complete multivitamin which includes iron of at least 18mg. Not all multivitamins contain iron, so you will have to read the package. This should be taken at least once daily. Calcium citrate is somewhat better absorbed than calcium carbonate, and vitamin D is necessary to maximize absorption of calcium from the GI tract. Many of our patients take Viactive™, or Caltrate Plus D™ (calcium carbonate), or Citracal™ (calcium citrate). Make sure your calcium supplement has vitamin D in it, and take an amount to equal at least 1000 – 1200mg / day. We also recommend not taking more than 600mg at a time as more than that may exceed the intestine’s ability to absorb all of it.

What can I take for constipation?

First we need to define constipation. It is an inability to have a bowel movement despite the accumulation of stool in the colon. Patients are usually quite uncomfortable. That is very different from infrequent bowel movements wherein there is little or no accumulation of stool in the colon, hence no bowels to move. Constipation after the gastric bypass procedure is actually not very common, while infrequent bowel movements are quite common. This is likely due to the paucity of oral intake in patients. There is no set schedule of bowel movements a person should have. The number is different for each person. If a patient is truly constipated, though, it is O.K. to take an occasional laxative of the patient’s choice. Chronic use of laxatives, however, is unhealthy for anyone, whether they have had a gastric bypass or not. Patient’s who have more than an infrequent bout of constipation should take a regular, daily fiber supplement such as Metamucil™, or Citrucel™, or the myriad others available over the counter. Fiber should always be taken with water. Gastric bypass patients may not be able to take a whole standard dose at once because they may not be able to drink that much water at once. They may take it as a divided dose.

When can I go back to work after a laparoscopic / open gastric bypass?

There is no set time that is right for everyone. The type of work you do (manual labor vs. desk job, etc.), your own pain/discomfort threshold, and other medical conditions you have effect this. In general, though, about 85-95% of patients are back to work 2-3 weeks after the laparoscopic approach, and 3-4 weeks after an open approach. You and your surgeon will share in that decision at your first post-operative visit.

What can I take for a headache?

Stomach surgery increases a patient’s risk of ulcers as does the use of non-steroidal anti-inflammatory drugs, known by the pseudonym, NSAIDs. These include medicines such as aspirin, acetaminophen, ibuprofen, and most of the over the counter pain medicines. Taken for the occasional headache, they are probably safe. Problems arise with chronic or repeated use of these medicines for aches, arthritis, etc., and they should be avoided in that scenario. We strongly advise against the powdered salicylates such as Goody’s Powders, Stanback, or equivalents in our gastric bypass patients.

Why am I so tired after my surgery?

Fatigue after gastric bypass surgery is common, and there are primarily two etiologies. First, the gastric bypass is a major operation. Although usually done through small incisions laparoscopically, it is still major surgery and as such is expected to tax the energy level of patients while they are recovering. Add to this the greatly diminished caloric intake of patients after surgery (patients are burning far more calories than they consume), and fatigue is not surprising.

Am I hypoglycemic (low blood sugar)? Is it something to be concerned with?

To answer this one must first understand a little blood sugar physiology. For most non-diabetics, blood sugar usually stays within a fairly narrow range, say 70 – 110mg/dl. If a person fasts, the blood sugar may drop below this range, perhaps significantly below this range – temporarily. Low blood sugar induces a series of hormones in the body which in turn mobilize glycogen, a storage form of sugar, in the liver turning it into glucose, which is then delivered into the blood stream thus raising the blood sugar again. It is this process which makes us feel badly when our blood sugar is “low,” yet it is an adaptive process. In other words, our body is reacting appropriately to the low blood sugar and is trying to elevate it. Most of the time, no treatment is necessary, and the feeling will pass on it’s own in 15-30 minutes. Hypoglycemia is not a reason to eat candy, or other simple sugars. In fact this will aggravate the problem by elevating the blood sugar too high, too rapidly, and the blood sugar will likely bottom out again subsequently as your pancreas “chases” the blood sugar with insulin. The feeling can be alleviated with a simple light snack consisting of a complex carbohydrate and some protein. Examples include one or two peanut butter crackers, a cheese cracker, or a quarter or half sandwich with lean luncheon meat such as turkey. Remember why you had a gastric bypass in the first place, and don’t overeat.

Special consideration is given to diabetics. Some previously poorly controlled diabetics have “adapted” to blood sugars which are elevated, and when the blood sugars come into a normal range, i.e., better control, after surgery, the patients experience symptoms of hypoglycemia when, in fact, they have normal blood sugar. These patients will simply take time to adjust back to good blood sugar control, and as they do the feelings of hypoglycemia will gradually subside. Conversely, diabetics on medication for blood sugar control can develop true and severe hypoglycemia as their blood sugars are artificially driven lower by their medications. Not all of the diabetes medications have this risk, but it is important for diabetic patients to have close follow-up by their endocrinologist or primary care physician both before and soon after gastric bypass surgery.

Can I take pills?

In general, yes. The gastric bypass has a larger opening out of the stomach than the vertical banded gastroplasty that was previously done for morbid obesity. Some patients prefer liquid medications after surgery, and we generally prescribe a liquid pain medication after surgery, but pills are O.K. If you are used to taking several different medications at once, however, your stomach may not be big enough for that, and you will need to separate those medications in time before taking.

When is the redness around the wound an infection?

The wounds are closed with an absorbable suture just beneath the skin, and a few millimeters of redness surrounding the wound is not uncommon, and does not necessarily indicate an infection. However, a wound that is becoming increasingly painful, has an area of redness that is also swollen and growing, or is associated with fever should be brought to the attention of your surgeon or their assistant.

Will I be hungry?

Most patients that have gastric bypass surgery notice a diminution in their appetite. In fact, it is usually quite profound initially, but may slowly return over time. Typically appetites remain suppressed below your preoperative appetite, however, and it takes far less food to quell that appetite. Because it takes so little food to satisfy that appetite, it is very important to eat very slowly even when you are “starving,” because overeating or eating too fast will initiate pain, nausea, and vomiting.

Will I have a change in bowel habits?

Most patients notice a decrease in the number of stools they have per week, probably due to the paucity of intake. However, some people do experience and increase in the number of stools with a decrease in the consistency of those stools, i.e., a trend toward diarrhea, possibly because of the bypass of some of the intestine. See “What can I take for constipation?”

What is the average weight lost?

This is different for every person undergoing the procedure and is dependent upon many variables such as: starting weight and BMI, age, physical activity, exercise, compliance with dieting. The chance of losing at least 50% of your excess weight is 60-80%.

What is Vitamin B12 and why do I need it?

Vitamin B12 is a micronutrient necessary for red blood cell production and proper formation of nerves. It is typically found in great abundance in foods such as red meat. Vitamin B12 is liberated from food in the stomach, bound to another molecule called “Intrinsic Factor” which is produced in the stomach, and that complex is absorbed from the last portion of the small intestine. Very little of the vitamin is used up on a daily basis, and the vitamin actually stays in the body for a long time after it is absorbed, thus we really only need it in tiny amounts. Gastric bypass surgery impedes the ability of patients to absorb vitamin B12 somewhat, but not entirely. Most patients require a supplement. Vitamin B12 can be supplemented easily either through periodic injections, an oral pill, a sublingual form which dissolves under the tongue, or a nasal spray.

Over time can my pouch stretch? Why can I eat more now than I used to?

There is indeed some stretching of the pouch over time. Initially after surgery, the pouch is somewhat inflamed and swollen due to the trauma of the operation. It is not very distensible, and therefore won’t hold very much. Over time, the pouch becomes more pliable and supple, and then can distend more. The amount of food one can consume at a meal will roughly triple over the course of a year. Also, foods of a more liquid consistency will empty out of the stomach faster than more solid foods or proteins, thus patients can eat more of a thinner consistency food than they can of a thicker or more coarse food. Patients should be wary of “liquid calories”, as they can be detrimental to weight loss efforts.

Can I drink alcohol?

Alcohol can be consumed in small amounts. Remember, though, alcohol is / are “liquid calories.”

Will my birth control pill still work?

We recommend patients use an additional means of birth control during their first year after gastric bypass surgery. There may be some alteration in the absorption or hormonal action of birth control pills during the rapid weight loss that occurs with gastric bypass surgery.

Will I have hair loss? If so, what can I do for it?

Some degree of hair loss is quite common with weight loss. Basically, the body will channel it’s available energy resources to essential processes during periods of caloric / protein deficiency such as can occur with the gastric bypass procedure. Growing hair and nails are not essential processes, therefore, growth slows and hair loss ensues. Typically this is a self-limited process. As caloric and protein intake approach the rate of utilization, weight loss slows, stops, and hair loss usually ceases as well. Most patients gradually regain the hair they previously lost. This may take a few years, however. Protein deficiency is probably mostly implicated in hair loss, and thus protein intake is encouraged to help minimize hair loss. Some patients also take biotin, zinc, and / or an extra vitamin, and many of these patients feel it helps them.

How much water should I drink daily?

The amount of water a patient should drink varies based upon their size, the ambient temperature and humidity, the patient’s activity level, use of fluid pills, and other factors. We generally recommend between 32 – 64 ounces daily. Keeping a water bottle with you to sip on all day long is a good habit.

Can I take my arthritis medicine after surgery?

Most arthritis medicines are also known to increase the incidence of ulcers in patients taking them. Patients with a surgically created connection between the stomach and intestine such as gastric bypass patients, are probably somewhat more prone to ulcers than those with un-operated stomachs. Thus, we recommend avoidance of arthritis medicines if possible. (See also, “What can I take for a headache?”) If you must take an arthritis medicine other than acetaminophen (Tylenol) or Celebrex, we recommend you simultaneously take a strong antacid medicine such as Prilosec, Protonix, Nexium, Prevacid, or other similar class medicine to afford some protection to the stomach and intestine.

Can I eat popcorn or citrus fruit?

Some surgeons are concerned that the undigested portions of these foods will plug the opening of the stomach, but we have not found that to be true. Previous obesity operations made a much smaller opening between the stomach and intestine, and avoidance of such foods was probably more important with those operations. Popcorn and citrus fruit in moderation are O.K. after the stomach has healed, about 6 weeks.

How long do I need to wait before I get pregnant?

Pregnancy should be avoided at least during the first twelve months after surgery, and during the active weight loss phase. When a patient’s weight plateaus, defined as staying within a five pound range over three months, pregnancy is acceptable as long as the patient’s OB-GYN doctor is agreeable.

When will I be able to have plastic surgery? Do you do plastic surgery?

When a patient’s weight plateaus, defined as staying within a five pound range over three months, plastic surgery is acceptable? Typically this occurs between 12 – 18 months after the operation, but may take considerably longer in some individuals. We do not do plastic surgery but can recommend several plastic surgeons to you, or you may have one in mind already.

What are the lifting restrictions after surgery?

No heavy lifting for 1-2 weeks after the laparoscopic gastric bypass, and about 8 weeks after the open gastric bypass. In general, though, no lifting will put more strain on your wounds than coughing or sneezing, and, unfortunately, we don’t have the ability to prevent you from doing that! Thus, lifting is seldom a source of wound disruption. We recommend common sense; don’t try to lift something if it hurts, and if you feel pain, stop.

How long do I need to wait after surgery before I have sex?

Typically sex is allowable after 1-2 weeks as long as it is comfortable. The same caveat applies here, if it hurts, don’t do it.

Can I have carbonated beverages?

Wait 6-8 weeks before trying carbonated beverages as they produce a lot of gas in the stomach and intestine. Even after that time, allow some of the effervescence to disperse, that is, let the drink go a little flat, before consuming.

Can I chew gum?

Yes.

Can I eat the peels such as on an apple or pear?

Yes.

When can I drive?

Usually after your first post-operative visit in the office your doctor will release you to drive, but that is decided on a patient by patient basis, so please check with your surgeon at the time of that follow-up appointment.

Nondiscrimination Statement:

Cahaba Valley Surgical Group, P.C. complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

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