Preparing for Your Bariatric Sugery

Pre-Operative Course at Providence Ensures Safe Procedures

The doctor will order pre-operative tests based on your physical exam and past medical history. The tests may include heart tests such as an echocardiogram, EKG and maybe a stress test. Another test may be an EGD. This is a test to look into the stomach and make sure the lining of the stomach is healthy. Some tissue may be sent to the lab for evaluation and to determine the presence of h.pylori. H.pylori is an organism found in the stomach that will need to be treated prior to gastric sleeve and roux-en-y bariatric procedures. Many patients are prescribed a sleep study to test for sleep apnea. Some additional labs test and other diagnostic test may be prescribed to ensure your safety during and after surgery.

All patients are expected to attend our nutrition class. The class is offered weekly and last one-hour. There is a fee for this class and you can schedule it in our office. All patients are expected to attend one pre-operative class and one post-operative class.

Our program dietitian educates our patients regarding the pre-surgical and post surgical diet. We de require strict adherence to our program diet. It is necessary for patients to bring their protein with them to the post-operative class. Please call our office if you have any questions about the diet. Relatives and supportive persons are encouraged to come to the class with you.

Please be aware, there are certain medications that must be stopped prior to surgery. These medications include but are not limited to aspirin, Motrin, Naprosyn, Aleve, Advil, blood thinners and any related medications. All herbal medications should be stopped 10 days before surgery and patients should avoid high doses of Vitamin E. Patients who are taking steroid medications e.g. prednisone will be asked to see the prescribing physician to discuss the impact of stopping the dose and in some cases just reducing the dose to at least 5mg daily prior to surgery. Please consult your primary care physician or your surgeon for specific questions.

Your bariatric surgery experience begins the day you first walk in our office

First you call the call-center and attend our informational session
Second, you are scheduled an appointment in our office
Third, during your first visit, you receive a list of consultations and test to complete and you are instructed that you need to lose weight prior to surgery
Fourth, you arrange to come for supervised weight loss meetings monthly with our dietician
Fifth, you schedule your appointment for nutrition class
Sixth, you begin reducing your calories and walking daily
Seventh, you schedule an appointment with your PCP to get any needed referrals for your consultations
Eighth, you call schedule your appointments with the consulting providers and keep your appointments making sure you have informed to send a copy of the results and clearance to our office at 202-448-4080, Fax number: 202-448-4082
Ninth, you confirm with the Medical Office Specialists in our office that all you consultation reports have been received and you have lost the weight required pre-operatively
Tenth, our office informs you that the insurance company has approved you for surgery and you have received clinical approval from the surgeon. You and the Medical Office Specialist agree to a surgical date

Advanced Procedures Require Shorter Hospital Stays

Most patients stay in the hospital approximately five to eight days after an open procedure and one to two days after a laparoscopic procedure. You will be discharged when you:

Are able to take enough liquids and nutrients by mouth to prevent dehydration
Have no fever
Have adequate pain control with medication

Depending on which procedure is performed, one or two small tubes may be placed around the stomach pouch and the bypassed stomach to drain body fluids after the surgery. These are usually removed in three to 10 days. To help prevent blood clots, anti-embolism stockings or other compression devices will be placed on your legs, and your surgeon will require you to attempt to stand up and move around as soon as possible, usually within the first 24 hours. Patients who use continuous positive airway pressure (CPAP) or bi-level positive airway pressure (BiPAP) for sleep apnea may be asked to bring their machines with them for use immediately after the operation.

Post-Operative Course Keeps Patients on the Road to Better Health

The educational process continues through into the postoperative period. At each postoperative encounter, patients are seen by a physician and a dietitian. These meetings are valuable opportunities for continued reinforcement of feeding and lifestyle guidelines. We adhere to the principle that all our efforts are essentially a form of behavior modification, and we understand that success is only gained through repetition and progressive cultivation and strengthening of our relationships with each individual patient.

Activity and Exercise Help the Healing Process

Both activity and exercise are essential to your recovery, as well as your weight loss. As stated before, this is not a sick surgery and you are expected to resume your normal activity as soon as possible within reason. You should get out of bed the same day of surgery, walk in the hall and sit in the chair. We caution you not to walk without the knowledge or assistance of your nurse. Pain medication may seriously impact your ability to walk safely without assistance. Although, you may be sore, once you are up and walking, you may find you feel even better!

After surgery you should be walking at least 30 minutes per day. You should begin your walking program the day you get home. Start slow, but try to walk in segments of 10 to 15 minutes 2 to 3 times per day and gradually increase to 30 minutes per day.

Remember surgery is a tool and exercise is essential in making it work. If you have joint pain, swimming is an excellent alternative. However, you must obtain consent from your Surgeon before getting into the pool; usually 4 weeks after surgery is ok! Other forms of exercise such as cycling, or aerobics you may find enjoyable. No weightlifting for 6 weeks. The key is to get moving. Discuss your exercise plan with your Surgeon before starting.

Understand When to Call the Physician:

Please let us know if you experience any of the following:

Redness, swelling or warmth from the incision sites
Increased pain or soreness in the surgical area
Fever greater than 100
Drainage from the incision that is thick, foul smelling or greenish in color
Nausea, vomiting, diarrhea
Inability to tolerate any liquids

Medications to avoid forever:

Motrin
Aspirin
Steroids
Naprosyn
Advil
Aleve
Pepto-Bismol
Any aspirin containing medication

Tylenol/acetaminophen is recommend for relief of minor pain or discomfort.

Pregnancy:

Infertility can be a significant co-morbidity for severely obese women. Many obese women experience irregular or non-existent menstrual periods. Surgery for obesity often corrects these problems. Due to the increased nutritional needs of pregnancy, we recommend that patients not get pregnant for at least one year, post bariatric surgery, when the initial rapid weightloss subsides. Patients should discuss these issues with their primary care physicians or Ob-Gyn.

For patients with the Laparoscopic gastric band, please notify us when you get pregnant, the Surgeon will have to remove the saline from the band to allow for adequate intake of nutrients for you and unborn child.

Irregular Periods:

For women who are still getting their periods, you may experience some short-term menstrual irregularities. Some patients may also find they will get their periods while in the hospital. It is not unusual to have your cycle start early, even as soon as 2 weeks following your last cycle. This is a result of the hormonal changes brought on by surgery, and you should be back to normal after a month or two. Any abnormal bleeding should be discussed with your gynecologist.

Emotional Changes:

Please be aware that some, but not all patients, experience emotional ups and downs. These feeling are perfectly normal, and should go away in time. If you feel you need someone to talk to, please call our office and we will refer you to a therapist. If you choose you may call the therapist you saw prior to surgery, they often suggest this as needed. You may want to call someone from the support group. Our monthly support group is very important and it helps patients tremendously.