Paradise Valley Hospital’s comprehensive weight-loss program offers surgical weight loss options for a healthier lifestyle. For people suffering from obesity with a Body Mass Index (BMI) of 35 or greater, surgical weight loss may be the best possible option. Our goal at Paradise Valley Hospital is to promote significant and lasting weight loss, a healthier, more active lifestyle and a fuller, more enjoyable quality of life.
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.
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. And 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.
The answer is “yes” – and that’s because calcium is extremely important for good health, and especially in women. Be sure your calcium supplements also contain Vitamin D – a substance that’s important as an agent in helping the body to absorb calcium.
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.
The good news here is that after about six months, such foods can be enjoyed by most patients without significant risk.
Probably not. Unless advised differently by your primary care doctor, you should be able to use salt freely.
40 to 65 grams a day are generally sufficient. Check with your surgeon to determine the right amount for your type of surgery.
That’s because red meat carries a high percentage of gristle, and if it isn’t chewed thoroughly, it could 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.
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”.
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.
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.
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. In addition, 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.
Eggs, low-fat cheese and cottage cheese, tofu, fish, dark-meat chicken and turkey are all good protein sources.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
You can shower the day after your surgery but you cannot 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.
Your surgeon does not consider a fever significant until your temperature is above 100.5. If it is above 100.5, call your surgeon.
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.
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.
Some patients will complain that their flatus is particularly foul smelling, however, most patients do not notice a difference.
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.
“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."
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.
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.
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 compression devices). Despite these precautionary measures the risk of DVT remains.
Infrequently: If needed, it is usually given after surgery to promote healing.
“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."
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.
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.
“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."
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 weight and fat distribution.
“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."
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.
Patients can return to normal sexual intimacy when wound healing and discomfort permit. Many patients experience a drop in desire for about 6 weeks.
Most patients have no difficulty in swallowing these pills.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Bariatric surgery is designed for those with a body mass index equal to or greater than 40, or equal to or greater than 35 with serious co-morbidities.
Call 1-888-3ABRAZO to locate a physician that specializes in Surgical Weight Loss or use our Find A Physician to locate a physician near you.