Slide 1 of 36 Welcome to the Before Your Weight Loss Surgery presentation. Patients who watch the weight loss surgery presentations know what to expect from surgery and the healing process. So, they are less nervous and are more active in their recovery. These patients have fewer problems and less pain. In other words, the patients that are more informed about their surgery have a more positive, more successful and safer experience. This presentation will help prepare you and any friends or family who watch this with you. [No audio] Main Menu Slide 2 of 36 What you will learn: This presentation will share with you: How to prepare for surgery What to expect before surgery What to expect during your hospital stay What you can do to reduce the risk of problems and promote healing If you have any questions about your surgery, outcomes or risks other than those covered today, please discuss with your doctor at your appointment. If your doctor s orders differ from the details given in these slides, please follow your doctor s orders. Slide 3 of 36 Types of weight loss surgery We currently do 4 types of weight loss surgeries: With the Vertical Sleeve Gastrectomy (VSG) the surgeon removes most of your stomach, leaving behind a stomach that s shaped like a banana. With the Roux-en-Y Gastric Bypass (RYGB) part of the stomach is separated from the rest of the stomach and formed into a smaller pouch. Your intestines are then divided and reconnected into a Y shape so that your food bypasses the majority of the stomach and travels directly from the pouch into the small intestines. With the Laparoscopic Adjustable Gastric Band (LAGB) the surgeon places a small silicone adjustable band around the top part of the stomach to create a small pouch above the band, so that you feel satisfied after eating a smaller amount of food.
Before Your Weight Loss Surgery With the Duodenal Switch (DS) the surgeon removes most of the stomach similar to the vertical sleeve gastrectomy. Then, the surgeon bypasses part of the intestines so you lose your weight because you re no longer able to absorb food in parts of the intestine. Please read the Making Your Decision handout to learn more about the different types of surgeries. You can also click the link above to watch a video about the surgeries. Slide 4 of 36 Preparing for surgery Your role in recovery begins weeks before your surgery. You will see over the next few slides how to prepare for surgery. You will also learn what other details are important to address before surgery, and what happens the day of surgery. Slide 5 of 36 About your pre-surgery appointments To begin, let s discuss all of your pre-surgery appointments. These include: Meeting your surgeon Weigh-in visit with the nurse Pre-op dietitian visit Pre Assessment Clinic (PAC) visit (meeting your anesthesia team) At your first visit with us, we gave you a pre-surgery task list of things to complete before your insurance company will approve the surgery. The pre-surgery task list was customized for you based on your insurance criteria and your medical history. We expected it to take 3 to 6 months to complete everything on this list. Watching this presentation is one of the tasks on the list, as is reading the Making Your Decision handout. You must complete both of these tasks before you make any of your pre-surgery appointments. If you have not already had your first visit or didn t get a task list, call 612-626-6666 to schedule an appointment. It is also important that you call your insurance and ask if they have an EXCLUSION for weight loss surgery AND to call us if your insurance company has an EXCLUSION. If this is the case, the insurance company will NOT pay for the surgery, no matter what information we send to them. Ideally, you should make this call right after your first visit with us. Slide 6 of 36 Pre-surgery appointment: meet the surgeon
When you ve completed your pre-surgery task list, call the pre-surgery nurse coordinator to set up your visit with the surgeon. You can also call the pre-surgery nurse coordinator if you have any questions about any of the tasks. During your visit with the surgeon, you will review the type of surgery you are planning to have done and the surgeon can answer any questions you may have. After the visit with the surgeon, please call our scheduler for a surgery date and to schedule the rest of your pre-surgery appointments. The scheduler will also be submitting the application to your insurance to obtain prior authorization for the weight loss surgery. Slide 7 of 36 Pre-surgery appointment: weigh-in visit About 3 to 4 weeks before your surgery date, you will have a weigh-in visit with the clinic nurse coordinator. The nurse will make sure that you are at your presurgery weight loss goal, give you pre-surgery instructions, and help you complete important forms. Losing weight before surgery makes the surgery safer. So, if for any reason you are not at your goal weight at this visit, your surgery date will be postponed until you are at your goal weight. You will need to schedule weigh-in appointments until you meet your goal weight. It is important to plan ahead if you want to fill out a Family Medical Leave Act (FMLA) form and/or disability form. You can discuss these forms with the surgeon and nurse and fill them out as a part of your weigh-in visit. You should also write a health care directive. A health care directive, also called an advanced directive, is a written legal document that states what health care you would want if you could not speak for yourself. It tells your family and care team about your wishes for treatment. Slide 8 of 36 Pre-surgery appointment: pre-op dietitian visit Your insurance company and our program require you to meet with a dietitian once a month for 3 to 6 months before you can have weight loss surgery. This is to help you make healthy choices with diet and exercise and to lose weight before surgery. Surgery is safer when you lose weight beforehand. Once you have met these guidelines and are at your pre-surgery goal weight, you will have one more pre-surgery dietitian visit about 3 to 4 weeks before surgery. At
this visit, the dietitian will review with you the diet changes you ll need to make after the surgery. You may be able to have this review at an earlier dietitian visit if you re already at your pre-surgery goal weight and maintain or continue to lose weight. Your dietitian will keep helping you with diet changes after surgery. You will need to schedule dietitian visits at: 1 week, 1 month, and 1 year after surgery, then once a year after that. You may also schedule other dietitian visits as needed between these times. Slide 9 of 36 Pre-surgery appointment: Pre Assessment Clinic (PAC) At the Pre Assessment Clinic you will meet with the anesthesia team that is in charge of putting you to sleep for surgery. This visit should happen after you ve met with your surgeon, but within 30 days of your surgery date. When you schedule this visit, let us know if you want to do your pre-op history and physical (often referred to as an H&P) at this visit, or if you d prefer to do that with your primary care doctor. If you choose to have your primary care doctor do this, it needs to be done before this visit. At this visit, you ll learn about how the team plans to put you safely to sleep for surgery. You ll also review any medicines and herbal supplements you currently take. You should learn which medicines you should stop taking before surgery and when to stop them. You should also know which medicines you should continue to take up to the morning of your surgery and how to take them. Your surgeon may also give you special guidelines. We will need to do some lab work after this visit to make sure your body is ready for surgery. We will tell you what needs to be done and help you schedule these visits. Slide 10 of 36 Preparing for surgery Now that we ve finished talking about your pre-surgery appointments, let s talk about other important details that need attention. Slide 11 of 36 Other prep: nicotine use As hard as it is to stop smoking or using nicotine (tobacco) products, you must do so both before and after surgery. This is important because nicotine and other harmful chemicals from cigarette smoking can cause many problems during and after surgery, including:
Delay healing of the incision (surgical cut) Increase your chance of infection at your incision Increase your chance of blood clots Increase your chance of stomach ulcers Increase breathing problems after surgery Slide 12 of 36 Other prep: nicotine use (continued) You must stop using all nicotine products at least 6 weeks before surgery. This includes: cigarettes, E-cigarettes, cigars, chewing tobacco, nicotine gum, lozenges, and patches. We will check your nicotine level and cotinine level at our Fairview Outpatient Lab on any day you meet with our team. You can check with your presurgery nurse coordinator to schedule this lab test. We will test you at least 2 weeks after stopping all nicotine products, and at least 4 weeks before surgery. Please note that it can take up to 7 days to get the results back. If you test positive for any level of nicotine, your surgery will be postponed until you test negative. Slide 13 of 36 Other prep: calls to make This is good time to plan the help you will need after surgery. You may need help with grocery shopping, preparing your meals, cleaning the house, doing laundry, taking care of pets, keeping up with yard work and getting rides to appointments and other activities. By asking people early, they can plan ahead and be ready to help you out. You will also need to preregister for surgery with the hospital. This can be done by phone, or it can be done online at www.fairview.org. Slide 14 of 36 Prepare: timeline before surgery The next few slides will show a timeline of the items we have discussed, starting about a month before your surgery. Beginning at 4 weeks, you should meet with your surgeon. Also check with the scheduler that they have everything needed to submit to your insurance company. At 3 to 4 weeks, have your weigh-in visit with the nurse and final presurgery dietitian visit.
Before Your Weight Loss Surgery At 2 to 3 weeks, have the Pre Assessment Clinic (PAC) appointment to meet with the anesthesia team and have your pre-op exam done. By this time you should also know which medicines to stop and when. One week before surgery, you should start practicing your breathing exercises discussed at the PAC visit. This is an important exercise you will be doing often after surgery. You should also get groceries and ask someone to plan on driving you home from the hospital. Slide 15 of 36 Prepare: timeline 48 hours before surgery, we want you to start the bowel prep, stop eating solid foods and start drinking only clear liquids. Clear liquids are liquids that you can see through. The dietitians will give you a list of liquids to choose from. Also don t chew gum or eat candy starting 2 days before surgery. If you are having the Sleeve Gastrectomy, the Roux-en-Y Gastric Bypass, or the Duodenal Switch, then you also need to take magnesium citrate at 8:00 am, 2 days before your surgery. You can buy this over the counter at a pharmacy or drug store. If you don t have a bowel movement by 2:00 pm, take another dose. We suggest you take time off of work to do this bowel preparation. You will also get a call from the hospital with details about your check-in. This includes the time you should arrive and where you should park and enter the hospital. This is also an important time to update your care team on ANY changes in your health. You should tell them about any changes all the way up to your surgery. This includes sore throat, runny nose, cough, fever, dental problems, trouble going to the bathroom and skin problems such as a rash, scrape or cut. A couple of days before your surgery is also a good time to pack the paperwork you will need at the hospital. This includes insurance information and a copy of your health care directive. You should also bring a list of current medicines with details about how much and how often you take them. DO NOT bring any of your own medicines to the hospital unless we tell you to do so. The hospital will have the medicines you will need and you will not be allowed to take your own. The exception to this, is you may bring to the hospital: inhalers, study drugs, birth control pills, or eye drops.
Before Your Weight Loss Surgery Slide 16 of 36 True or false This slide has a question. Once the question has been asked, you will be given 7 seconds to think about it before the answer will be given. It s okay to answer, even if you re unsure. The presentation will continue after we explain the answer. TRUE or FALSE: You should take magnesium citrate at 8:00am, 2 days before surgery to clear out the intestines prior to the sleeve gastrectomy surgery. TRUE - magnesium citrate helps clear out your intestines before surgery. You should also take it if you are having the Roux-en-Y or duodenal switch surgery. Take magnesium citrate at 8:00 am, 2 days before your surgery. You can buy this over the counter at a pharmacy or drug store. If you don t have a bowel movement by 2:00 pm, take another dose. We suggest you take time off of work to do this bowel preparation. Slide 17 of 36 Prepare: timeline The day before surgery: You should confirm your ride to and from the hospital. Pack your personal items and continue to follow your drinking guidelines. You should have already stopped eating solid foods. You should pack clean, loose-fitting clothing like sweatpants, T-shirts, a robe, comfortable tennis shoes and toiletries. You should also pack enough for 2 to 3 days in the hospital. Do not drink after midnight the night before surgery. You can have sips of water with your medicine only until 3 hours before check-in. Take a shower the evening before surgery, following the instructions we give you. You can use Scrub Care, Hibiclens or other antibacterial soap. You can wash your hair with your regular shampoo. DO NOT shave your surgical site. DO NOT apply hair spray, lotions or powders after your shower. Slide 18 of 36 Prepare: timeline On the morning of your surgery: Do not eat or drink anything. If your doctor says it is okay to take your morning medicine, take it with a small sip of water at least 3 hours before check-in.
Remove all jewelry and artificial nails or nail polish. Please leave all your valuables at home. This includes your wedding ring. The hospital is not responsible for lost items. Don t forget to pack any special equipment you will need. If you use a C- PAP or Bi-PAP machine for breathing at night, be sure to bring it with you to the hospital. The hospital can give you one if needed, but you ll get a better fit if you bring your own. If you have any adaptive equipment like a cane or walker, pack that as well. This is a good time for the physical therapist to check and adjust (remove-them) those items. PLEASE be sure to label all your personal items. Take a second shower the morning of surgery using the special surgical soap. Call the hospital or tell your surgeon s nurse if you have cold or flu-like symptoms or have a cut, scrape or rash on the surgical site or elsewhere on the abdomen. These can delay your surgery. Plan to arrive two hours before your surgery time. Slide 19 of 36 Time for a Question Another question for you. Again, once the question has been asked, you will be given 7 seconds to think about it before the answer will be given. This question is multiple choice. How many showers should you take with surgical soap before surgery? A. one (the morning of surgery) B. two (one in the evening and one in the morning) C. four (two in the evening and two in the morning) D. none B. two showers (one in the evening before surgery and one the morning of surgery). This helps prevent infection. Slide 20 of 36 True or false A few more questions for you. Again, once the question has been asked, you will be given 7 seconds to think about it before the answer will be given. These two questions are True or False. TRUE or FALSE: Your pharmacist will tell you which medicines to take the morning of your surgery.
FALSE. You will talk about which medicines to take at your Pre Assessment Clinic visit. Your surgeon or primary care doctor may also give you guidelines. TRUE or FALSE: You may bring your own medicine to take while in the hospital if it is an inhaler. TRUE The only medicine you can bring to the hospital with you are inhalers, study drugs, birth control pills, or eye drops. Slide 21 of 36 What to expect: day of surgery Over the next few slides, you will learn what to expect the day of your surgery. Slide 22 of 36 What to expect: check-in / pre-op When you arrive to the hospital on the day of your surgery, you will discuss everything from your allergies to specific pain medicines that work well for you. Your vital signs will be taken, including your weight, temperature, blood pressure and pulse. We will also review your health history. An ID tag and allergy bracelet will be put on you at this time. The hospital will check your bracelet often and ask your name each and every time they give you a medicine or treatment. You may find it annoying, but we do this for your safety during your hospital stay. You will read and sign a consent form. Make sure you understand the consent form before signing. Your surgeon will explain the risks and possible problems of surgery at this time. You will meet with your surgeon for the last time before surgery. You will also meet a few members of the anesthesia team, the person helping you go to sleep during the surgery. They will decide what medicine is best for you after reviewing your chart and talking with you and your surgeon. Be sure to tell them about any surgery you have had before. Your visitors can come with you to the pre-op area, and the surgeon will meet with them after surgery in the waiting lounge. Slide 23 of 36 What to expect: check-in / pre-op
We will also attach special equipment to you in the pre-op area. These items help us keep you safe during surgery. An oximeter measures the oxygen in your blood. Oxygen gives you extra oxygen as needed. An intravenous (IV) line gives you medicine and fluids through a small needle in your vein. A heart monitor measures your heart rate and rhythm. Plexi-pulse foot wraps help improve blood circulation and decrease risk of blood clots. We may also clip or shave any hair at your incision site. Slide 24 of 36 What to expect: length of surgery How long the surgery takes depends on which surgery it is: Adjustable Gastric Band surgery takes 45 to 90 minutes Sleeve Gastrectomy is 1 to 2 hours Roux-en-Y Gastric Bypass is 1½ to 2½ hours Duodenal Switch lasts for 4 to7 hours Slide 25 of 36 What to expect: your surgery incisions You will have 5 small incisions, or surgical cuts, after surgery. Each cut is about half an inch long. After surgery, these are closed with 2 to 3 staples, steri-strip tape, glue or stitches under the skin. After the surgery, your surgeon will tell you which method or combination of methods were used. If you have staples, they may be removed before you go home and replaced with Steri-strips. Steri-strips and glue will fall off on their own. You do not need to do anything with these. If you have stitches (sutures) under your skin, your body will absorb these in a week or two. Slide 26 of 36 What to expect: recovery Once your surgery is done, we will take you to the recovery room called the postanesthesia care unit (PACU), where the nurses will watch you while you are waking up.
This usually takes about 1 hour. Voices may sound louder than usual, your thoughts may be unclear and your vision may be blurry. You may also have dry mouth, sleepiness, dizziness or weakness. Be sure to tell the nurse about how you are feeling. This is especially important if you have nausea, pain or feel cold. The nurses will check your vital signs often. They will also ask you to cough, do deep breathing exercises, and use the incentive spirometer. You may also still have an IV line in your arm, a clip on your finger to measure oxygen, and a tube in your nose for extra oxygen. We will remove these when you no longer need them. Slide 27 of 36 What to expect: hospital room When you are awake and stable, we will bring you to your room. We will tell your visitors where you are and when they can see you. During your short time in the hospital, we would like you to turn every two hours. The nurses can help you with this if needed. You should also take small walks 4 to 6 times a day. Try to increase your distance a little each time. When you walk, you can take off your plexi-plus foot wraps that are used to increase blood flow in your legs. These activities are vital to help prevent blood clots by keeping blood flowing. You will also be using a device called the incentive spirometer for your breathing exercises. You should do these exercises every hour while in the hospital. Keep doing them at home until the doctor tells you to stop. This is usually when you go back to normal activities. Another breathing exercise that we suggest is to take a breath and hold it for 5 seconds. Do this 10 times every hour while awake. Cough after your tenth breath. The breathing exercises and incentive spirometer help prevent pneumonia. It is also important to drink lots of water. Sip water and other liquids as directed by the dietitian and nurse. There will be some swelling at your stomach from the surgery which will make it harder to drink for a couple of weeks. Go slow with drinking and advancing your diet. Your goal is to drink 48 to 64 ounces of water a day. It s time for another question. Slide 28 of 36 True or false
TRUE or FALSE: Walking after surgery can help prevent blood clots. TRUE walking after surgery increases blood flow through the body. This helps prevent blood clots and pneumonia. Slide 29 of 36 What to expect: pain management Weight loss surgery is major surgery, so there will be pain after. Our goal is to make you as comfortable as possible so you can be up and moving around to prevent blood clots and pneumonia. Your nurse will ask questions to find out about your pain and what is working to decrease it. Everyone feels pain in a different way, so the nurse depends on you to tell them how you feel. You and your nurse can work TOGETHER to stay ahead of the pain. Don t wait until the pain is unbearable to ask for pain medicine. To help control your pain, let the nurse know when your pain starts to increase. Do not wait until the pain is the worst it can be! Also tell your nurse if the pain medicine isn t working or is causing nausea or a rash. Pain medicines can help you heal faster and help prevent problems. Slide 30 of 36 What to expect: pain management There are different ways to manage pain. The nurse can use a few different ways to make you feel comfortable. Other ways to relieve pain include: Creating a diversion with music or the TV Using aromatherapy like lavender to relax Using guided imagery to focus on something pleasant Focus on slowly breathing in and slowly breathing out using your chest and abdominal muscles Taking deep sighs Going for walks to move your muscles Slide 31 of 36 What to expect: other symptoms Besides pain at your incisions, let the nurse know if you have other symptoms such as: Sore throat Headache Nausea
Fatigue Anxiety Shortness of breath Chest pain Trouble sleeping Slide 32 of 36 What to expect: your role in recovery You can lower your risk of problems after surgery by paying attention to a few simple details in the hospital and at home: Pneumonia affects your lungs: so doing breathing and coughing exercises, using your incentive spirometer and moving around often are all very important. Be sure to tell your doctor if you cough all the time or have shortness of breath, chest pain or fever. To lower your chance of getting a blood clot: drink plenty of clear liquids, keep moving and take your blood clot medicine, if it's prescribed. To reduce the risk of infection, make sure your home is clean, wash your hands often and follow instructions about wound care and taking showers after surgery. Do not immerse the incision in water until it is completely healed (check with your doctor first). Be sure to watch for signs of infection such as fever, redness and drainage at the incision. If you have these symptoms, tell your care team right away. Also report signs of a urinary tract infection such as frequent voiding, burning when you urinate and fever. Constipation is another problem that happens often after surgery. You can reduce your chance of constipation by drinking plenty of clear liquids and following the diet guidelines your dietitian gives you. You may also use a laxative or stool softener. Check with the surgeon s team before you change any of your other prescription, over-the-counter medicines or supplements. These can affect how the medicines you already take work. Slide 33 of 36 What to expect: goals for going home Before you can leave the hospital, you will need to meet certain goals. Some goals are strength and endurance goals: Walking a certain distance Climbing stairs (if you have stairs at home) Getting on and off the toilet by yourself Getting in and out of bed by yourself or with little help Being able to get out of your home in case of an emergency Other goals include: Having good health
Knowing how to manage your pain Knowing which medicines to take and how to take them The pharmacist can check with the doctor for discharge prescriptions on medicines that may need to be changed. Slide 34 of 36 What to expect: goals for going home If you have had an Adjustable Gastric Band surgery, you may go home the same day as your surgery, or the next day. For the Sleeve Gastrectomy surgery or the Roux-en-Y gastric bypass, you will stay 1 to 2 days. Some patients go home the day after surgery. Patients having Duodenal Switch surgery often stay in the hospital 2-3 days. Bring comfortable clothes and shoes to wear when you leave the hospital, and plan for a friend or family member to give you a ride home. Remember that no matter how long you stay in the hospital, you should have somebody give you a ride home. You should also ask someone to stay with you the first couple of days you are home. And, make sure you have done your grocery shopping before your surgery day. Slide 35 of 36 True or false And one last question. This is another true or false question, but this time there is no right or wrong answer! TRUE or FALSE: I found this presentation helpful. Slide 36 of 36 Congratulations! This is the end of your Before Weight Loss Surgery presentation. You are now better prepared for your surgery! If you have any questions about your surgery, the recovery or your hospital stay, please feel free to call us or ask us questions during your clinic appointment. You may also visit our website at www.umnwls.org. Please note that your care team may modify some or all of the information in these slides to fit your specific situation. Always follow the guidelines your care team gives you. Thank you.