FAQ

Diet and Exercise

• What is Dumping Syndrome?

  “Eating sugars or other foods containing many small particles when you have an empty stomach can cause dumping syndrome in patients who have had a gastric bypass or BPD where the stomach pylorus is removed. Your body handles these small particles by diluting them with water, which reduces blood volume and causes a shock-like state. Sugar may also induce insulin shock due to the altered physiology of your intestinal tract. The result is a very unpleasant feeling: you break out in a cold clammy sweat, turn pale, feel ""butterflies"" in your stomach, and have a pounding pulse. Cramps and diarrhea may follow. This state can last for 30-60 minutes and can be quite uncomfortable – you may have to lie down until it goes away. This syndrome can be avoided by not eating the foods that cause it, especially on an empty stomach. A small amount of sweets, such as fruit, can sometimes be well tolerated at the end of a meal."

• Do I need to take Iron?

  Yes. Some multivitamins do not contain iron or do not contain enough to maintain appropriate iron stores and for this reason some patients will need to supplement with other iron supplements. This is especially true for women that are still menstruating (having a period) on a monthly basis. Many young women despite their weight are anemic (low blood count) prior to undergoing gastric bypass surgery.

• Do I need to take Calcium?

  Yes. Calcium supplements are also extremely important, especially in women. Calcium supplements should also have Vitamin D, a necessary component for the absorption of calcium.

• Will I be allowed to drink alcohol?

  You will find that even small amounts of alcohol will affect you quickly. It is suggested that you drink no alcohol for the first year. Thereafter, with your physician’s approval, you may have a glass of wine or a small cocktail on occasion.

• “Will I be able to eat ""spicy"" foods or seasoned foods?"

  Most patients are able to enjoy spices after the initial 6 months following surgery.

• Is there any restriction of salt intake?

  No, your salt intake will be unchanged unless otherwise instructed by your primary care physician.

• How can I be sure I am eating enough protein?

  40 to 65 grams a day are generally sufficient. Check with your surgeon to determine the right amount for your type of surgery.

• Why can’t I eat red meat after surgery?

  You can, but you will need to be very careful, and we recommend that you avoid it for the first several months. Red meats contain a high level of meat fibers (gristle) which hold the piece of meat together, preventing you from separating it into small parts when you chew. The gristle can plug the outlet of your stomach pouch and prevent anything from passing through, a condition that is very uncomfortable.

• Why can’t I snack between meals?

  Snacking, nibbling or grazing on foods, usually high-calorie and high-fat foods, can add hundreds of calories a day to your intake, defeating the restrictive effect of your operation. Snacking will slow down your weight loss and can lead to regain of weight. Most patients find that keeping a bottle of flavored (non-sugar) water satisfies the need for snacking.

• Is there a problem with consuming milk products?

  Milk contains lactose (milk sugar), which is not well digested. This sugar passes through undigested until bacteria in the lower bowel act on it, producing irritating byproducts as well as gas. Depending on individual tolerance, some persons find even the smallest amount of milk can cause cramps, gas and diarrhea. Also, milk has a moderate ammount of sugar that makes for high calorie intake.

• When should I start taking nutritional Suplementations (vitamins)?

  You should begin to take your multivitamin supplements and calcium supplement at least two weeks prior to surgery. Vitamins should be in a chewable form. Adult forms should be taken as directed, usually one pill a day. We do not recommend child formulations such as the Flintstones Complete.

• Why drink so much water?

  When you are losing weight, there are many waste products to eliminate, mostly in the urine. Some of these substances tend to form crystals, which can cause kidney stones. A high water intake protects you and helps your body to rid itself of waste products efficiently, promoting better weight loss. Water also fills your stomach and helps to prolong and intensify your sense of satisfaction with food. If you feel a desire to eat between meals, it may be because you did not drink enough water. In addition, after the operation some patients will be quite fatigued. It is not uncommon that the cause is from dehydration. The importance of staying well hydrated cannot be over emphasized.

• What are the best choices of protein?

  Eggs, low-fat cheese, low-fat cottage cheese, tofu, fish, other seafood, chicken (dark meat), turkey (dark meat).

• How long will I be off of solid foods after surgery?

  Most surgeons recommend a period of four weeks or more without solid foods after surgery. A liquid diet, followed by semi-solid foods or pureed foods, may be recommended for a period of time until adequate healing has occurred. Your surgeon will provide you with specific dietary guidelines for the best post-surgical outcome.

Pre-Operative Process

• Why does it take so long to get insurance approval?

  After all of your consultations are completed, it usually takes your doctor 1-2 days to send a letter to your insurance carrier to start the approval process. The time it takes to get an answer can vary from about 3-4 weeks or longer if you are not persistent in your follow-up. Most treatment centers have insurance analysts who will follow up regularly on approval requests. It may be helpful for you to call the claims service of your insurance company about a week after your letter is submitted and ask about the status of your request.

• What are the routine tests before surgery?

  Certain basic tests are done prior to surgery: a Complete Blood Count (CBC), Urinalysis, and a Chemistry Panel, which gives a readout of about 20 blood chemistry values. Often a Glucose Tolerance Test is done to evaluate for diabetes, which is very common in overweight persons. All patients, but the very young, get a chest X-ray and an electrocardiogram. Women may have a vaginal ultrasound to look for abnormalities of the ovaries or uterus. Other tests, such as pulmonary function testing, echocardiogram, sleep studies, GI evaluation, cardiology evaluation, gallbladder ultrasound or psychiatric evaluation, may be requested when indicated.

• What is the purpose of all the tests?

  An accurate assessment of your health is needed before surgery. The best way to avoid complications is to never have them in the first place. It is important to know if your thyroid function is adequate since hypothyroidism can lead to sudden death post-operatively. If you are diabetic, special steps must be taken to control your blood sugar. Because surgery increases cardiac stress, your heart will be thoroughly evaluated. These tests will determine if you have liver malfunction, breathing difficulties, excess fluid in the tissues, abnormalities of the salts or minerals in body fluids, or abnormal blood fat levels.

• Why do I have to have a GI Evaluation?

  Patients who have significant gastrointestinal symptoms such as upper abdominal pain, heartburn, belching sour fluid, etc., may have underlying problems such as a hiatal hernia, gastroesophageal reflux or peptic ulcer. For example, many patients have symptoms of reflux. Up to 15% of these patients may show early changes in the lining of the esophagus, which could predispose them to cancer of the esophagus. It is important to identify these changes so a suitable surveillance or treatment program can be planned.

• Why do I have to have a Sleep Study?

  The sleep study detects a tendency for abnormal stopping of breathing, usually associated with airway blockage when the muscles relax during sleep. This condition is associated with a high mortality rate. After surgery, you will be sedated and will receive narcotics for pain, which further depress normal breathing and reflexes. Airway blockage becomes more dangerous at this time. It is important to have a clear picture of what to expect and how to handle it.

• Why do I have to have a Psychiatric Evaluation?

  The most common reason a psychiatric evaluation is ordered is that your insurance company may require it. Most psychiatrists will evaluate your understanding and knowledge of the risks and complications associated with weight loss surgery and your ability to follow the basic recovery plan.

• What impact do my medical problems have on the decision for surgery, and how do the medical problems affect risk?

  Medical problems, such as serious heart or lung problems, can increase the risk of any surgery. On the other hand, if they are problems that are related to the patient’s weight, they also increase the need for surgery. Severe medical problems may not dissuade the surgeon from recommending gastric bypass or Lap Band surgery if it is otherwise appropriate, but those conditions will make a patient’s risk higher than average.

• If I want to undergo a gastric bypass or Lap Band surgery, how long do I have to wait?

  After you have attended one of our bimonthly seminars, a one-on-one consultation can be scheduled with one of our surgeons within a week or two. Once a patient is seen, if the surgeon and patient agree it is appropriate, the operation can usually be scheduled within 4 to 8 weeks. The time before surgery is required to obtain the appropriate preoperative tests and insurance authorization.

• What can I do before the appointment to speed up the process of getting ready for surgery?
  • Select a primary care physician if you don’t already have one, and establish a relationship with him or her. Work with your physician to ensure that your routine health maintenance testing is current. For example, women may have a pap smear, and if over 40 years of age, a breast exam. And for men, this may include a prostate specific antigen test (PSA).
  • Make a list of all the diets you have tried (a diet history) and bring it to your doctor.
  • Bring any pertinent medical data to your appointment with the surgeon – this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
  • Bring a list of your medications with dose and schedule.
  • Stop smoking. Surgical patients who use tobacco products are at a higher surgical risk.

Post-Operative Care

• Are there any documents that you have created for your post-operative patients?

  Yes, we have created a handout for both our bypass and lap-band patients, you can download it here:
  Lap Band Post-Op Handout
  Gastric Bypass Post-Op Handout

• Why did my surgeon leave a drain in place and how do I take care of it?

  The drain is called a Jackson-Pratt drain. You can see the exterior portion of the drain only. The interior portion of the drain resides inside your body and is located nearby the new connection between your stomach pouch and your bypassed limb of intestine. It has been placed as a precaution just in case your staple line leaks. If it were to leak, the drain would catch leaking stomach juices and allow it a path for removal from your body so as to prevent you from getting sick. Care of the drain is simple and requires that you empty the drain every 24 hours or when it fills up. You should record the amount of fluid in cc (cubic centimeters) every time you empty the drain and write it down on your log sheet which you would have received when you discharge from the hospital. Also, your discharging nurse should go over drain care and how to empty the drain prior to discharge.

• When can I return to work?

  This depends on the individual and the type of work that the person does. People with desk jobs or more sedentary work can go back as early as 7 days after surgery. Patients with more lifting in their jobs usually go back to work 3 weeks after surgery. Most patients who have had the laparoscopic gastric bypass procedure return to work within 3 weeks of their surgery.

• When can I start working out or do heavy lifting?

  If your surgeon does not repair a hernia during your gastric bypass, you can start doing mild exercises in as little as 7-10 days after surgery. More intense workout regimens should be avoided until 3 weeks after surgery. Heavy lifting is okay 6 weeks from your date of surgery.

• When can I drive?

  The time a patient starts driving is variable and depends mostly on the patient. If you are still taking oral pain medications, it is recommended that you do not drive since it will dull your reflexes! Also, if you are still having a significant amount of muscle pain, it is recommended that you do not drive, as the pain may slow your movement during instances when you might have to hit the brakes or turn rapidly! In general, we recommend that you have someone bring you to your first post-operative office visit (usually one week from the day you had surgery). Your surgeon will ask you about your level of pain and your use of pain medications and will often allow you to drive after this point (one week after surgery).

• When can I shower or take a bath?

  You can shower the day after your surgery but you can not take a bath (immerse under water) for 2-3 weeks after surgery. It is okay to shower with your drain hanging at your side in the shower.

• What do I do if I develop a fever?

  Your surgeon does not consider a fever significant until your temperature is above 100.5. If it is above 100.5, call your surgeon.

• What do I do if one of my incision sites looks red and becomes painful to the touch?

  This usually represents a port site infection and is almost always at the left-most (the patient’s left) incision on your body. It is treated by opening the wound in the office and packing twice a day with sterile, moist gauze as well as oral antibiotics.

• Will I run out of pain medications at home?

  Most patients do not take pain medications after one week and thus will not run out of medications. If you do not use all your pain medications, we ask that you discard the remainder. For those who still require pain medications, we will authorize a prescription refill. Most patients have the most pain at the left-most (patient’s left) incision on their body. This site is where one of the surgical staplers is introduced into your abdomen by the surgeon during the operation. In order to do this, he/she has to stretch out your muscle and tissues at this incision so as to be able to fit the stapler into your abdomen. This is why this site is usually the most painful. However, this site is also where infections of the skin, muscle, and tissues occur in 5 % of our patients. Sometimes, this incision must be opened up by your surgeon in the office. If this occurs, you will need to pack this site with moist gauze for 2-3 weeks in most cases.

• Is it true that my bowel movements and flatus will have a different smell?

  Some patients will complain that their flatus is particularly foul smelling, however, most patients do not notice a difference.

• How long will it be before I pass flatus (gas) or have a bowel movement after surgery?

  Although this can vary, it usually takes 2-5 days after surgery before flatus is passed. Your first bowel movement after surgery usually occurs at this time as well.

• Will I feel bloated after my surgery?

  “Immediately after surgery, you will feel bloated due to the gas that you had placed into your abdomen from the laparoscopic procedure as well as the gas that was placed into your intestines during the endoscopy that is performed at the time of your gastric bypass. The feeling of bloating usually resolves when you start having flatus. Some patients will experience cramping after surgery which is usually related to the build up of gas in the intestines from the surgery. This "gas pain"usually resolves with flatus."

• Will I get a copy of suggested eating patterns and food choices after surgery?

  Surgeons provide patients with materials that clearly outline their expectations regarding diet and compliance to guidelines for the best outcome based on your surgical procedure. After surgery, health and weight loss are highly dependent on patient compliance with these guidelines. You must do your part by restricting high-calorie foods, by avoiding sugar, snacks and fats, and by strictly following the guidelines set by your surgeon.

• Do I meet with a nutritionist before and after surgery?

  You will meet our nutritionist at the seminar where a brief overview of your dietary modifications after surgery will be discussed. Our nutritionist will visit you in the hospital after your surgery. In some instances a phone conversation will be needed. Following this he or she will be in close phone contact with you throughout your 4 stages of eating after surgery. A nutritionist is available for phone consultation on "as needed" basis for any questions you may have relating to nutrition.

• What is phlebitis and is it preventable?

  Undesired blood clotting in veins, especially of the calf and pelvis. It is not completely preventable, but preventive measures will be taken, including: early ambulation, special stockings, blood thinners and SCDboots (sequential compressiond devices). Despite these precautionary measures the risk of DVT remains.

• Is blood transfusion required?

  Infrequently: If needed, it is usually given after surgery to promote healing.

• What is a hernia and what is the probability of an abdominal hernia after surgery?

  “A hernia is a weakness in the muscle wall through which an organ (usually small bowel) can advance. Approximately 20% of patients develop a hernia after ""open"" surgery. This is a rare complication after the laparoscopic approach. Most of these patients require a repair of the herniated tissue. The use of a reinforcing mesh to support the repair is common."

• Will I have to change my medications?

  Your primary care physician or other medical doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolve after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Usually no change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the-counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to compensate. When potassium levels get too low, it can lead to fatal heart problems.

• What if I am really hungry?

  This is usually caused by the types of food you may be consuming, especially starches (rice, pasta, potatoes). Be absolutely sure not to drink liquid with food since liquid washes food out of the pouch. It is recommended to drink water before a meal.

• Will I be miserably hungry after weight loss surgery since I’m not eating much?

  “Most patients say no. In fact, for the first 4-6 weeks patients have almost no appetite. Over the next several months the appetite returns, but it tends not to be a ravenous ""eat everything in the cupboard"" type of hunger."

• Will exercise help with excess hanging skin?

  Exercise is good in so many other ways that a regular exercise program is recommended. Unfortunately, most patients may still be left with large flaps of loose skin depending on the pre-surgery weigth and fat distribution.

• What can I do to prevent lots of excess hanging skin?

  “Many people heavy enough to meet the surgical criteria for weight loss surgery have stretched their skin beyond the point from which it can ""snap back."" Some patients will choose to have plastic surgery to remove loose or excess skin after they have lost their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). However, some do pay for certain types of surgery to remove excess skin when complications arise from these excess skin folds. Ask your surgeon about your need for a skin removal procedure."

• How can I know that I won’t just keep losing weight until I waste away to nothing?

  Patients may begin to wonder about this early after the surgery when they are losing 20-40 pounds per month, or maybe when they’ve lost more than 100 pounds and they’re still losing weight. Two things happen to allow weight to stabilize. First, a patient’s ongoing metabolic needs (calories burned) decrease as the body sheds excess pounds. Second, there is a natural progressive increase in calorie and nutrient intake over the months following weight loss surgery. The stomach pouch and attached small intestine learn to work together better, and there is some expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose weight to the point of malnutrition.

• Is sexual activity restricted?

  Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about 6 weeks.

• Will I be able to take oral contraception after surgery?

  Most patients have no difficulty in swallowing these pills.

• Is there any difficulty in taking medications?

  Most pills or capsules are small enough to pass through the new stomach pouch. Initially, your doctor may suggest that medications be taken in liquid form or crushed.

• What if I’m not hungry after surgery?

  It’s normal not to have an appetite for the first month or two after weight loss surgery. If you are able to consume liquids reasonably well, there is a level of confidence that your appetite will increase with time.

• What will the staples do inside my abdomen? Is it okay in the future to have an MRI test? Will I set off metal detectors in airports?

  The staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium so small it is hard to see other than as a tiny bright spot. Because the metals used (titanium or stainless steel) are inert in the body, most people are not allergic to staples and they usually do not cause any problems in the long run. The staple materials are also non-magnetic, which means that they will not be affected by MRI. The staples will not set off airport metal detectors.

• Can I get pregnant after weight loss surgery?

  It is strongly recommended that women who have the Roux-en-Y gastric bypass or the Lap Band wait at least 18 months after the surgery before a pregnancy. Approximately 18 monthsr post-operatively, your body will be fairly stable (from a weight and nutrition standpoint) and you should be able to carry a normally nourished fetus. Those pateints who have Lap Band surgery may require removal of the fluid from the band if pregnancy ensues. The Lap Band itself will generally not need to be removed. You should consult your surgeon as you plan for pregnancy.

• What is done to minimize the risk of deep vein thrombosis/pulmonary embolism or DVT/PE?

  Because a DVT originates on the operating table, therapy begins before a patient goes to the operating room. Generally, patients are treated with sequential leg compression stockings and given a blood thinner prior to surgery. Both of these therapies continue throughout your hospitalization. The third major preventive measure involves getting the patient moving and out of bed as soon as possible after the operation to restore normal blood flow in the legs. You may be required to continue blood thinning therapy for two weeks after you are discharged from the hospital.

• How soon can I drive?

  For your own safety, you should not drive until you have stopped taking narcotic medications and can move quickly and alertly to stop your car, especially in an emergency. Usually this takes 7-14 days after surgery.

• How soon will I be able to walk?

  Almost immediately after surgery doctors will require you to get up and move about. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter. On leaving the hospital, you may be able to care for all your personal needs, but will need help with shopping, lifting and with transportation.

• Will the doctor leave a drain in after surgery?

  Most patients will have a small tube to allow drainage of any accumulated fluids from the abdomen. This is a safety measure, and it is usually removed in the doctor’s office one week after the surgery. Generally, it produces no more than minor discomfort.

• How long do I have to stay in the hospital?

  As long as it takes to be self-sufficient. Although it can vary, the hospital stay (including the day of surgery) can be 1-2 days for Lap Band surgery, 2-3 days for a laparoscopic gastric bypass, and 3-5 days for an open gastric bypass.

• Will I have a lot of pain?

  Every attempt is made to control pain after surgery to make it possible for you to move about quickly and become active. This helps avoid problems and speeds recovery. Often several drugs are used together to help manage your post-surgery pain. While you are still in the hospital, a Patient Controlled Analgesia (PCA), which allows you to give yourself a dose of pain medicine on demand, may be used by your physician. Various methods of pain control, depending on your type of surgical procedure, are available. Ask your surgeon about other pain management options.