BARIATRIC GUIDE FOR PATIENTS (New Patient Information)
Thank you for your interest in surgical treatment of obesity. The following information will help educate you about the benefits and risks of weight loss surgery. You will find out what you will need to do to be successful. In addition, you will find information on the support group and questionnaires that must be completed prior to your first visit. We hope you find this information beneficial.
You are facing an important decision in your life. This decision is serious and should be well thought out. We believe the surgeons at NCSA, in association with The Bariatric Center of the Rockies provide a clear choice.
Roux-en-Y Gastric Bypass
This is considered a restrictive, slightly mal-absorptive weight loss operation. This surgery combines the creation of a small stomach (pouch) to restrict food intake and construction of an intestinal bypass of the duodenum to cause slight mal-absorption. Patients who have Gastric Bypass can expect to lose 70% of their excess weight within one to two years.
The surgeons at NCSA have been performing this surgery since 2010. This is a restrictive surgery that limits the amount of food a person can eat. It is also effective in resolving diabetes, sleep apnea, hypertension and high cholesterol. The Sleeve Gastrectomy provides about 60% excess weight loss which can be achieved within one to two years.
Although many bariatric clinics have stopped offering lap-band, we still offer it to patients who can convince the surgeon they are a good candidate. Dr. Robert Quaid is the only NCSA surgeon who offers lap-band to highly motivated patients who have a BMI in the low 40s, and are extremely motivated to stay away from sugar and to exercise. In this surgery a silicone band is placed around the upper portion of the stomach. Patients come in on a monthly basis for adjustments. Depending on how much fluid is in the band will determine how much food a person is able to eat. Lap-band patients generally lose approximately 40% of their excess weight in about 2 years. Some of the complications that can occur with the lap-band include nausea, vomiting, reflux, slippage, infection of port, erosion of the band, and leaks.
Doctors Robert Quaid, James Dickinson, Stefan Pettine and Michael Roller perform the weight loss surgeries at NCSA. Our doctors are general surgeons who are board certified and associated with the American Society for Metabolic and Bariatric Surgery and also the American College of Surgeons. Each of these surgeons has many years of experience doing bariatric surgery. Because there are four surgeons they are able to assist each other with Gastric Bypass and Sleeve Gastrectomy, so generally you have two surgeons doing your surgery, which is a huge benefit to our patients.
Throughout this process you will be under the guidance and care of Becki Mudgett, RN, CBN (Certified Bariatric Nurse). Becki has been with NCSA since 1995 when Dr. Otteman first started doing GBP. She has been instrumental in creating the educational materials, facilitates the Light for Life support group and sees patients both preoperatively and postoperatively. She works closely with the doctors and will assist you with any needs or concerns. Becki is an active member of the ASMBS, attending the annual conferences as participant, speaker and past Chair of the membership committee.
Weight loss surgery is a serious undertaking. Each individual should clearly understand the proposed operation and risks involved. Patients will meet with their surgeon for a consult and risks and benefits will be discussed and all questions will be answered.
Improvement or resolution of most co-morbid illnesses can be expected. Close to 75-80% resolution of diabetes, sleep apnea, hypertension and high cholesterol are achieved after Gastric Bypass and Sleeve Gastrectomy. Depending on the surgery approximately 60-80% excess weight loss is also realized. A person’s quality of life is vastly improved which usually brings about a psychological improvement as well. However, it is not unusual to experience a little depression immediately after surgery. Since food is so prevalent in our lives, there is a big psychological impact with weight loss surgery, which is why all of our patients will see a bariatric mental health provider prior to surgery. NCSA also offers a support group that meets the last Monday of each month at PVH, Café F, 6-8pm. Becki facilitates this support group and it is attended by many people. This support group is open to the public and all future patients are encouraged to attend. (See Support Group link for agenda.)
Your doctor will go over the risks and complications of your surgery to include leaks, bleeds, blood clots and other complications. Although these happen infrequently, it is important for you to realize their potential.
- About 20% of patients who have bariatric surgery develop gallstones. If this occurs and you are experiencing problems, we will remove your gallbladder.
- There is a possibility for patients to develop nutritional deficiencies such as anemia, osteoporosis and metabolic bone disease. These deficiencies can usually be avoided by maintaining vitamin and mineral intake.
- Women of childbearing age should avoid pregnancy until their weight becomes stable; usually 1-2 years after surgery. Weight loss and nutritional deficiencies and result in a more difficult pregnancy and more dangerous for the baby.
- Your doctor will discuss additional risks during your consultation
(up to one year after the surgery)
- Nausea, vomiting, bloating and/or heartburn, usually caused by:
Eating too much too fast
Drinking with meals
Not chewing food adequately
Using drinking straws
Eating rich or sweet foods
Eating gas-producing food
Drinking carbonated beverages
Band too tight or slippage
- Dumping Syndrome (usually associated with Gastric Bypass but can also occur with Sleeve Gastrectomy)
This occurs when food is eaten that is high in sugar. The food is dumped from the stomach into the small intestine resulting in nausea, weakness, flushing, rapid pulse, heart pounding, sweating and/or clammy skin, abdominal cramping and finally diarrhea. It takes about 30 minutes for this episode to go away. To avoid dumping syndrome, stay away from food and drinks high in sugar and do not drink with meals. You may drink about 30 minutes after you eat.
- Blockage of stoma (Gastric Bypass)
The new opening created in the surgery is smaller than the original opening that releases food from the stomach into the small intestine. This new opening may become blocked if too big a bite has been taken and/or it did not get sufficiently chewed up. To prevent this take small bits, chew well and take time while eating. If this does happen, it is not an emergency and patients should call our office for advice.
Eat three small meals and two or three snacks each day.
Eat slowly. Set timer for 1-2 minutes between each bite
Stop eating as soon as you are full
Constant grazing will cause weight regain or minimize your weight loss.
- Anemia and Hair Loss
Anemia most commonly occurs in premenstrual patients and those that do not take their vitamins. This is usually preventable and easily treated. However, if it becomes severe, patients may need to have IV iron infusions. With rapid weight loss there is usually hair loss. This is temporary, your hair will grow back and can be minimized by getting all your protein and vitamins.
- Unlikely to lose weight successfully with (further) nonsurgical measures?
- Well informed about the surgical procedure and the effects of treatment?
- Determined to lose weight and improve your health and lifestyle?
- Willing to accept responsibility for making the necessary changes in dietary habits, knowing that the more compliant you are, the more success you will attain?
- Aware of how your life will change after the operation (adjusting to the side effects of surgery, including taking small bites, chewing well, taking time between bites and taking vitamin supplements for the rest of your life?
- Aware of the potential for serious complications and dietary restrictions?
- Free of any severe psychological, emotional or medical problems which would make the surgery unsuccessful?
- An individual who is not drug or alcohol dependent?
- Willing to stop smoking cigarettes and/or marijuana? Must quit 3 months prior to surgery and we will do testing prior to surgery.
- Committed to lifelong medical follow up?
- Have a body mass index of 40 or more?
- Have a body mass index of 35-40 with serious health problems aggravated by obesity?
- Have high risk obesity related health problems such as diabetes, sleep apnea, hypertension, pulmonary problems or obesity related heart disease?
You will attend an hour long educational seminar prior to your visit with the surgeon. The consultation with the doctor will take about an hour. You will have ample opportunity to address any questions or concerns you may have. We strongly encourage you to bring your spouse, significant other, friend or family member to this initial visit. Please do not bring young children.
As you consider Bariatric surgery as a solution for your obesity, it is important you understand the operation is an excellent means of managing your weight, but its success depends on you making significant lifestyle changes. This operation is a tool and will bring about weight loss by forcing you to change your eating habits. You must use this tool correctly. You will receive a 3 ring binder, Patient Guide with everything you need to know after surgery. The greatest success is realized by patients who are positive in their attitude about adjusting their eating patterns. For a successful outcome, it will be necessary for you to exercise regularly and follow post-operative dietary guidelines. Many bariatric patients lose 100 pounds or more during the first year following surgery. In addition to having a positive impact on their physical well-being, they are more active, emotionally healthier and enjoy a higher quality of life.
Perhaps the most significant change following bariatric surgery is your loss of hunger. Your medical team will prescribe a dietary program to help you achieve your weight loss goal while maintaining good health after surgery. The primary objective is to eat foods with the highest possible nutritional value. Because you should lose weight at a rapid rate, proper nutrients are absolutely essential to maintain overall health, muscle tone, skin elasticity and to minimize hair loss.
The first two weeks following surgery, you will be sipping liquids and pureed food designated by your medical team. During this time, it most important to stay hydrated. Soft foods will be added to your meals after your first post op visit. At your six week post op appointment, if all is going well, you will be advanced to a regular diet. All of this information will be in your Patient Guide.
Exercise is an essential part of your long-term care and treatment and should begin prior to surgery. Exercise is the biggest indicator of long term success. We know that many of patients are limited in this regard, but everyone can start someplace and that is all we ask.
The Gastric Bypass and Sleeve Gastrectomy surgeries usually require a hospital stay of two days. Lap-Band patients will generally go home after one day. If you live more than two hours from Fort Collins, you will need to remain in the area for a few days after discharge from the hospital. The Concierge Service at Poudre Valley Hospital (495-8580) will assist you in finding discount lodging options.
Patients are usually able to return to work in 2 weeks, depending on what they do. If your job is more active and vigorous, it may take longer. Follow up appointments include 2 weeks, 6 weeks, 3 months, 6 months, 1 year and annually. We have a lifetime commitment to our patients. To avoid long-term problems, we recommend you come for annual visits, do blood work and see your doctor. If you live a long distance away and cannot travel for the annual follow up, we ask that you have your general physician perform these tests and send a copy of the results.
The primary goal of our medical team is to improve your health. We also want you to make an informed decision by being fully aware of the responsibilities, benefits and possible complications of the surgery. The decision to move forward with surgery belongs to you and your family doctor. Should you elect to have bariatric surgery, you will receive dietary, exercise and behavior modification guidelines to assist you. The tools and support are designed to help you achieve success and maintain long term goals. By taking responsibility to follow these guidelines you will maximize your overall success and minimize potential complications.
If you wish to proceed, your first phone call should be to our Bariatric Navigator, Michelle Carpenter. She will make sure you are a candidate for surgery and check with your insurance company to see if the surgery is a covered benefit. She will also determine if there are prerequisite conditions that must be met. Please call Michelle at 970-495-8316.