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Bariatric Surgery Questions

Patients often have bariatric surgery questions before and after their procedure. We hope the following bariatric surgery questions can help answer some questions you may be wondering about.

  • What is “dumping syndrome” – and why should I avoid it by avoiding sugars and other foods that contain small particles?

    As you’ve probably learned by now, consuming granules of sugar or other food that contains numerous small particles on an empty stomach can cause “dumping syndrome” for patients who’ve undergone a gastric bypass procedure or BPD in which the stomach pylorus has been removed.  Your body processes these particles through dilution with water – and such dilution can quickly lower blood volume, triggering a shock-like reaction.  Too much sugar may also trigger insulin shock, as a result of the altered physiology of your intestinal tract. Such shock can cause you to break out in a cold sweat, along with turning pale and developing a “pounding pulse.”  Diarrhea and cramping may also ensue. The syndrome can continue for 30-60 minutes and may be intense enough that you feel the need to lie down until it ends.  The syndrome can be avoided by staying away from the “food triggers” that bring it on – and especially on an empty stomach. Most gastric bypass patients can tolerate a small amount of sweets at the end of their meal, such as might be found in a piece of fruit. 

  • Should I be sure to take iron supplements?

    Yes, and it’s important to remember that multivitamins don’t usually contain enough iron to provide sufficient amounts.  That’s why some patients will have to add iron supplements to their diet. This is especially important for women who are still having monthly periods. Remember also that many young women are anemic (which means they have low blood-counts) before undergoing gastric bypass surgery.

  • Should I take calcium supplements?

    The answer is “yes” – and that’s because calcium is extremely important for good health, especially in women.  Be sure your calcium supplements also contain Vitamin D – a substance that’s important  in helping the body to absorb calcium.

  • Should I drink alcohol after the surgery?

    No.  Patients who have been through the procedure will notice that even relatively small amounts of alcohol can have a large impact, and quickly.  Doctors recommend that patients stay away from alcohol completely during the first year.  After that, with the approval of your physician, small amounts of wine or an occasional cocktail may be enjoyed without harm. 

  • How about spicy or heavily seasoned foods?

    The good news here is that after about six months, such foods can be enjoyed by most patients without significant risk.

  • Will I need to watch my intake of salt?

    Probably not.  Unless advised differently by your primary care doctor, you should be able to use salt freely.

  • I know I should be sure to eat enough protein. How much is right?

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

  • I’ve been told that I shouldn’t consume much “red meat” after surgery. Why not?

    That’s because red meat carries a high percentage of gristle. When gristle isn’t chewed thoroughly it can block the outlet of your stomach pouch causing significant discomfort.  For that reason, most patients should avoid red meat entirely – or at least for several months after surgery.  

  • Should I avoid “snacks” between meals?

    Absolutely.  Snacking on fat-rich foods between meals can add hundreds of calories to your intake each day.  It could also slow down your weight loss program.  For many patients, keeping a bottle of flavored, sugar-free water nearby is the best way to stop the “snack-craving”.   

  • How about milk products? Are they a potential problem?

    Unfortunately, the answer is often “yes”.  Because milk contains a sugar that isn’t easily digested (lactose), it remains intact until it reaches the lower bowel, where certain types of bacteria metabolize it.  Depending on their individual reaction to lactose some patients will experience gas, cramps and diarrhea after consuming even small amounts of milk. 

  • How soon should I begin taking vitamins after the surgery?

    Actually, you should begin multivitamin and calcium supplements about two weeks before your surgery.  Remember that you should take the “chewable” version, and that they should be taken as directed.  Take the adult form – usually one pill per day.

  • Why do I need to drink large volumes of water?

    It’s simple: when you shed excess pounds, your body needs to eliminate many waste products, and most of the elimination is carried out via urine.  But these waste products can cause crystals to form in the kidney, resulting in painful kidney stones.  Drinking more water helps your body to eliminate more wastes, thus protecting against stones.  This strategy also helps promote weight loss.  Water fills the stomach, triggering the “full” feeling that will help you eat less.  Also, some patients experience sharp fatigue after surgery, frequently caused by dehydration.  Staying properly hydrated is extremely important.

  • What are the best sources of protein?

    Eggs, low-fat cheese and cottage cheese, tofu, fish, dark-meat chicken and turkey are all good protein sources.

  • How long will I have to forego solid foods after gastric bypass surgery?

    About four weeks without solid foods is the usual recommendation from surgeons.  A liquid diet (perhaps followed by pureed foods for a while), will be required in order to promote healing.  Consult with your family doctor and your surgeon to obtain dietary guidelines that will ensure the best possible outcome.

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  • 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 begin the approval process. The time it takes to get an answer can vary from 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 except 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 assessment will help us to avoid potential complications. 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. Since surgery increases cardiac stress, your heart will be thoroughly evaluated. Other 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.  Up to 15% of patients with reflux symptoms may show early changes in the lining of the esophagus. Esophageal changes 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 typically 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. Narcotics 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. When medical problems 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. However, certain serious medical 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. If the surgeon and patient agree it is appropriate to move forward with bariatric surgery 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.

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  • 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:
    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. 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 when you need to hit the brakes or turn rapidly. In general, we recommend that you have someone bring you to your first postoperative 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.

  • 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 incision to the left-most side of your body. The incision 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. We will authorize a prescription refill for patients requiring further pain medication. Most patients have the most pain at the incision on the left-most side of their body. This site is where one of the surgical staplers is introduced into your abdomen during the operation. In order to do this, your surgeon has to stretch 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 the incision is reopened you will typically need to pack the site with moist gauze for 2-3 weeks.

  • 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 placed into your abdomen from the laparoscopic procedure as well as the gas that was placed into your intestines during the endoscopy 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 buildup 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, 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?

    Phlebitis is 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 SCD boots (sequential compression devices). Despite these precautionary measures the risk of phlebitis or 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 illness such as blood pressure and diabetes can be stopped when the conditions and symptoms improve or resolve after weight loss surgery. For meds that need to be continued the vast majority can be taken 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 food intake after weight loss surgery potassium levels are already likely to lower. When potassium levels get too low, it can lead to fatal heart problems.

  • What if I am really hungry?

    Extreme hunger is usually caused by the types of food you are 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 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 weight and fat distribution.
  • What can I do to prevent lots of excess hanging skin?

    Many people heavy enough to meet the criteria for bariatric surgery have stretched their skin beyond the point at which it can "snap back." Some patients will choose to have plastic surgery to remove loose or excess skin after losing their excess weight. Insurance generally does not pay for this type of surgery (often seen as elective surgery). Some insurances do pay 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 wonder about this early after the surgery when they are losing 20-40 pounds per month or 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 except 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 meaning 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 months 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 patients 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. 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 each day 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.

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

    As long as it takes to be self-sufficient. 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.

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If you have any further questions not covered in our bariatric surgery questions page call us at 1.877.362.9898. You can also complete our contact us form to schedule an appointment with us.

About your new self at Detroit Center in Michigan

Detroit Medical Center is the premier provider of weight loss surgery in Michigan and the Great Lakes Region. DMC operates offices in the Madison Heights and Southfield areas of Detroit, Michigan, and serves other areas including Ypsilanti, Saginaw, Ann Arbor, Detroit, Flint, Livonia, Monroe, Lansing, Dearborn, Novi and Troy. Your New Self also serves Canadian bariatric patients as a preferred provider for the Ontario Ministry of Health.

Your New Self at Detroit Medical Center boasts four expert bariatric surgeons who specialize in LAP-BAND®, REALIZE® Band, Sleeve Gastrectomy, and Roux-en-Y Gastric Bypass bariatric surgeries.

Patients interested in weight loss surgery should sign up for a free informational seminar to learn more about their surgical options and get started today.