Informed Consent and the Quiz
It is very important that you understand the risks and benefits of your operation prior to your surgery date. At your second or pre-surgical office visit with Dr. Belsley, you will take a short quiz so that you can have an additional discussion regarding various important issues prior to your operation. The purpose of the quiz is to assist your understanding and provide a source of conversation regarding the risks and benefits of the procedure. You will also be asked to review, initial and sign a consent form that discusses a number of important possibilities of your operation.
The Incentive Spirometer
You will be given an incentive spirometer by our nursing staff after the operation. The way to use the machine is to breath in deeply so that you cause the balls inside the machine to lift approximately half way up the machine. Immediately after your operation, your lungs will be in a condition of atelectasis where the air filled balloons that exchange oxygen and carbon dioxide are collapsed. Using the incentive spirometer ten times an hour can help you expand your lungs and mobilize the secretions that occur during anesthesia.
The importance of getting out of bed and walking after your operation
As soon as possible after your operation, your hospital team will encourage sitting in a chair and walking around (ambulation). The idea behind this is that early mobilization helps with blood flow in your legs so that you chance of having a blood clot will decrease. Standing upright (or close to upright in a chair) helps you breathe deeply and expand your lungs. This lung expansion will help mobilize the secretions in your lungs that build up during surgery and therefore help prevent pneumonia.
The need for the bariatric surgical diet
Although you are probably concentrating your thoughts on the actual operation and the immediate time period after your procedure, please remember that bariatric surgery is permanent. You will only have a good result if you follow diet and exercise guidelines. You need to take special precautions regarding your diet for the rest of your life. Although you will likely be able to tolerate most foods, you can’t eat whatever you want and have to commit to a healthy diet.
You must commit to keeping Dr. Belsley informed
Especially in the first thirty days after your operation, you must keep Dr. Belsley informed regarding any new medical problems that may develop. Please do not go to some emergency room that is close to your home unless absolutely necessary. Even if this is necessary, please communicate with our office.
Continuing Follow-Up and Annual Visits
It is very important that you attend all of your follow-up visits with Dr. Belsley after your procedure. These visits occur at regular intervals depending on your progress after the operation. Long-term we would appreciate that you come to office-visits once a year so that we may follow your long term progress and possibly identify any chronic bariatric related problems that your primary care provider might not appreciate.
The Hospital Diet
You will be placed on our 4 x 4 diet immediately after your operation. This diet starts at one ounce of liquid consumed very slowly over the course of an hour. You will be slowly advanced every four hours until you can drink four hours of liquid in one hour. You may go home if you feel well, can tolerate four ounces of liquid an hour and meet our other discharge criteria.
Motivate yourself to return home
While the hospital staff will do everything to make you comfortable during your stay, try to keep focused and motivated so that you may return home as soon as possible. This means that you should try to walk around, use your incentive spirometer and follow the bariatric 4 x 4 liquid diet as much as possible. Dr. Belsley's average patient stays two days after a laparoscopic gastric bypass or laparoscopic sleeve.
Vitamins and Protein Supplements
Although vitamins are very important to your long term health after bariatric surgery, you do not need to worry very much if they make you feel nauseous the first week or two after your operation. You may start your vitamins and protein supplements the day after you leave the hospital and are at home. If they do not make you feel well, do not worry. As long as you can keep yourself hydrated with water, you are likely doing just fine and can start the vitamins and protein at a later date.
Care with Eating and Drinking
After bariatric surgery, you will probably feel nauseous and possibly vomit if you eat too much, too fast, or if you eat the wrong kinds of food. You must also be careful not to wash food out of your new stomach or pouch. You need to not drink any liquids for 15 minutes before and then one hour and one half after your meals.
High Protein Foods
Although the data is still not absolutely clear, a diet that is high in protein is likely better for weight-loss and the high-metabolic state that your body will be in after the operation. Foods that are high in protein include cottage cheese, yogurt, eggs (especially egg-whites), tuna and beans
Activity in the month after surgery
You should try to be lightly active when you return home after your operation. You should try to walk both inside and outside your home as much as possible. Do not spend all day in bed and try to avoid heavy lifting for thirty days after your operation.
Emergency Signs after your operation
Dr. Belsley and his team are generally available for your questions after the operation via the office phone. Important signs to worry that mandate a phone call to Dr. Belsley include a very rapid heart rate that is sustained after your operation. A heart rate that is greater than 120 beats / minute is normal with exercise. If you are lying down and don’t feel well and find that your heart rate is 120 beats / minute or greater than please call our office. While a little bit of pain and an occasional episode of vomiting is considered normal, you must call our office if you can’t keep any liquids down and if you have severe abdominal pain.
Long Term Exercise and Weight Loss
Nothing is guaranteed with regards to bariatric surgery and your potential weight-loss. The numbers that are quoted with each procedure are an estimate of excess weight loss that is estimated based on the results of both Dr. Belsley as well as what is considered consistent with the results of others published in the surgical literature.
Exercise is very important to long term weight loss. You must be ready to start a formal exercise program as soon as thirty days after your procedure. The American Heart Association recommends approximately 30 minutes of cardiovascular exercise 5 times / week.
When to go back to the gym
You are typically cleared to go back to the gym one month after your operation. Please however use moderation and listen to what your body tells you. Start with low impact cardiovascular activity and then start to work in with weights and core exercises.
Depression and Anxiety after your Operation
If you have a previous diagnosis of depression or anxiety and you have previously been prescribed medications, then you should continue to take your medication in the immediate time up to and after your operation. Do not make your own decision to stop these or any other medications. If you feel extremely anxious or depressed after your operation then please speak with your psychiatrist, clinical psychologist or a member of Dr. Belsley’s team. Do not return to old eating habits and do not keep your problems to yourself.
What Vitamins are needed after your Operation?
The standard vitamins that you should take after a gastric bypass include: a multivitamin, Vitamin B12, Calcium and Iron. If you have had a gastric sleeve or a Lap-Band then a multivitamin and Vitamin B12 are typically recommended. Even if you feel fine, you cannot stop taking your vitamins- you must take vitamins for the rest of your life.
Dumping syndrome may occur after a gastric bypass. The dumping syndrome is not typically associated with patients who have had sleeve surgery or a Lap-Band. If you eat or drink sweets that are high in sugar then you will feel sick. This may also occur if you eat and drink at the same time. Dumping syndrome occurs when the food that you eat passes too quickly out of your stomach and into your intestine. Nausea, vomiting, bloating and abdominal cramps may occur almost immediately after eating foods high in fat and sugar. Foods that are high in sugar may also cause weakness, sweating and dizziness that occur one to three hours after eating.