Frequently Asked Questions: Gastric Bypass Surgery at CMC

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1 Frequently Asked Questions: Gastric Bypass Surgery at CMC Please feel free to talk with any member of the Obesity Treatment Center team at Catholic Medical Center regarding any questions, concerns or comments you may have. To sign up for a free information session on weight loss surgery at the Obesity Treatment Center, call QUESTIONS Q: Why have I been requested to lose weight prior to surgery? ANSWERS A: Losing weight prior to surgery may decrease the risk of complications, by decreasing the size of the liver, improving diabetes control and hypertension. It also demonstrates commitment to the lifestyle changes necessary to be success postoperatively, i.e. healthy, balanced diet and exercise. Q: What tests will I need prior to surgery? A: All required tests will be reviewed with you at your initial appointment, which will include labs and EKG. Additional testing, including radiology tests, sleep study, or cardiac testing will be determined on an individual basis. Q: How long will I be in the hospital? A: The hospitalization is typically 2-3 days, depending on your recovery. Q: How often will I need to come back for followup and continue to follow-up? A: You will be seen at 2 weeks by the surgeon s office and the RD at the OTC. After the initial visit you will return in one month, then every three months with both the dietitian at the OTC and your surgeon s office for the first year. You will then be seen at 18 months, 2 years, and ANNUALLY FOR LIFE. We strongly encourage you to stay connected to the program as much as possible by attending post-operative support meetings as well. If you are struggling or have concerns, we encourage you to schedule an appointment with your surgeon s office or the OTC at anytime. Q: What do I do if I am feeling nauseous? A: Evaluate your eating behavior. You may be eating too much and/or too fast. It is important to keep food records to see if this is related to certain foods. If nausea persists, call your surgeon s office or dietitian for recommendations. Occasionally anti-nausea medication may be needed shortterm. Q: What should I do if I am constipated? A: Pain medications are constipating. Try to wean off pain medication as you can. You may need to increase your fluid intake. You can also try Milk of Magnesia, diluted prune juice or stool softener. Q: What do I do if I have gas and bloating? What A: Gas is common after surgery. Continue to walk

2 do I do if I have diarrhea? Q: Will I be able to take my prescribed medications? regularly as per the physical therapy guidelines/goals given to you at your discharge from the hospital. Some patients develop lactose intolerance and may experience gas, bloating and diarrhea due to milk sugar called lactose. Symptoms should resolve by switching to lactosefree products. You can also try anti-gas medications available over the counter, i.e. gas-ex, phazyme (chewable or liquid form). If symptoms do not subside call your surgeon s office. A: You will need to crush pills or open all capsules the first month. It is important that you continue all medications as per instructions, and DO NOT abruptly discontinue any medications, unless instructed to do so. Check with your surgeon s office if you are unclear. After the first month, you can start taking small pills whole and cut in half larger pills. Q: What will my diet be like after surgery? A: The dietitians will carefully instruct you on the diet stages that you will progress through postoperatively. There are five stages to the diet. It is important that you follow this EXACTLY for your healing process and to avoid complications. Diet advancement may be altered or slowed depending on each individual. Q: What is Dumping syndrome? A: Dumping syndrome occurs when concentrated foods such as sweets or concentrated carbohydrates rapidly empty from the stomach pouch into the intestine. You may experience nausea, sweating, bloating, cramping and/or diarrhea. Everyone does NOT necessarily experience dumping syndrome, but you should be aware that eating foods high in sugar may cause this reaction. Q; Will I ever be able to tolerate normal food again? Q: Why is it important for me to drink fluids after surgery? A: You will be slowly advanced through the diet stages to eventually eat a healthy, balanced diet of whole foods. The difference will be the quantity/portions. You may have some food intolerances and need to avoid certain foods. These may include soft breads, pasta, rice, dry meats, fruit skins or leftovers/reheated foods. You should eventually eat a variety of HEALTHY food options. A: It is important to maintain your fluid intake of 64 ounces or more to maintain appropriate body levels of fluid and replace losses due to weight

3 Q: Why is protein so important in my diet right after surgery? Q: Are there any nutritional supplements that I will need to take after surgery? Q: What could be causing me to feel a tight feeling in the middle of my chest while I am eating or right after I eat? Q: How often do I need to get my labs/blood work done? Q: Can I eat foods that are high in fat and/or sugar after surgery? loss. Symptoms of dehydration may include lightheadedness, fatigue, nausea, and dry skin. A: After gastric bypass surgery we initially focus on meeting protein needs first. Protein is an important building block for healing, maintaining lean muscle and organ function. Your goal is grams per day. Please keep food logs to track your intake and review with the dietitian. You may require a protein supplement, i.e. shake or bars, long-term to meet these needs. A: Due to the limited capacity of your new stomach pouch and bypassing of the upper portion of your intestine (duodenum), you will not be able to get adequate amounts of some vitamins and minerals in your diet. You are REQUIRED to take vitamin and mineral supplements FOR LIFE. Compliance with these supplements is important to avoid vitamin/mineral deficiencies. At a minimum you will be taking TWO complete multivitamins daily, mg calcium citrate with added vitamin D, and vitamin B mcg sublingual tablet once weekly. Additional supplements may be recommended based on your lab results. A: A tight feeling after or while eating is usually a warning sign that something about your eating behavior or food consistency is not right. Carefully re-evaluate your eating. Refer to your food records. If this feeling persists, call your surgeon s office. A: You will need to have labs done every 3 months the first year. These are typically done prior to your follow-up appointments with the surgeon s office, so they can be reviewed with you at your visit. You will then have labs done at 18 months and ANNUALLY FOR LIFE. Please be sure to return to your surgeon s office to have these monitored. Your primary care physician will likely not be aware of the specific labs that need to be monitored long-term after gastric byass. A: Foods high in fat and sugar are also typically high in calories, and not part of a healthy, wellbalanced diet that you will need to follow to achieve and maintain weight loss. Sugars and fats may not be tolerated after gastric bypass and may

4 cause symptoms such as nausea, vomiting, pain and diarrhea. Q: When am I allowed to drive after my surgery? A: You are allowed to drive once you are no longer taking narcotics (pain medication), and you have enough mobility to react behind the wheel. This may take a week or two. Q: When can I return to work? A: You can return to work as soon as you feel able to perform your job duties. You will not be able to lift/pull/push more than 10lbs for 6 weeks. Typically recovery time is 2-4 weeks. Q: When can I start? 1. Walk? 2. Swimming? 3. Lifting weights? 4. Aerobics? 5. Abdominal crunches? A: Always check with your clinician before beginning any exercise program. 1. Immediately! You will be discharged from the hospital with a daily walking plan. 2. Do not start swimming until you have had your initial check with the surgeon s office to ensure adequate healing and get clearance to start swimming. 3. You cannot lift more than 10lbs for 6 weeks post-operatively. 4. We encourage cardiovascular exercise immediately. Depending on the specific activity always ask first. Start slowly. 5. No abdominal exercises for 6 weeks postoperatively. Q: How much weight will I lose the first month? A: Weight loss depends on many factors, including starting weight, age, gender, activity level, caloric intake and adherence to diet guidelines. Q: How big will my stomach be after surgery? A: Approximately 1 ounce or the size of a golf ball. Q: Why am I losing so much hair? Will I go bald? A: Most patients will experience some hair thinning after surgery. This typically occurs between 3-9 months post-operatively during your rapid weight loss. This is your body s response to the stress of rapid weight loss and significant caloric reduction. It may be accelerated if you are not compliant with your supplements or not meeting your protein goals. Hair loss usually slows/stops around 9-12 months post-operatively when your weight loss starts to slow. You will not go bald and hair loss is usually not permanent. Regrowth will occur. Q: I often hear that people experience vomiting after surgery. Should I expect to vomit? A: Vomiting is not a common or expected occurrence. If you are vomiting, please evaluate your diet, eating habits and food consistency. Please adhere to the dietary guidelines given to you. If you do not tolerate a particular food, please

5 leave it out of your diet for at least a month before retrying it or discussing it with the dietitian. Remember to chew, eat slow, take small bites, sip your liquids and make sure foods are moist. Drink fluids separate from your meals. Do not eat and drink at the same time. Any early vomiting is concerning. This can be a sign of a more serious problem or cause complications as you are healing. Call your surgeon s office immediately if you have vomiting.

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