Frequently Asked Questions
Getting Started
What should I expect during the initial
evaluation?
You will meet with the surgeon
and the bariatric clinical dietitian specialist.
You will undergo a complete history and physical
exam, nutrition screening and discussion
regarding surgery. The initial evaluation
takes about one to two hours (including wait
time).
What do I do after the initial screening
prior to surgery?
You will have psychology
evaluation. You will need to go to your primary
doctor, a cardiologist, and possibly a pulmonologist
to get medical clearance for surgery. You will
also need to obtain a few medical studies.
These will be tailored to your individual health
problems and will be explained when you meet
with the surgeon.
How long is the usual wait between the
initial visit and surgery?
The wait between the initial visit and surgery
on average is eight to twelve weeks depending
on your insurance company and how quickly
you can obtain your medical clearances.
Who do I contact with questions before surgery?
You
can call the Bariatric Surgery Program Administrative
Assistant at Penn Presbyterian Medical Center
at 215- 662-9198
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About
Surgery
How much will the procedure cost?
Procedure
costs differ depending on the patient. Each patient’s
surgery is unique and may encounter different
difficulties post-operatively. However, many
insurance companies will cover the cost of the
surgery, since morbid obesity can become a life
threatening condition. Each patient should
confirm with his or her own insurance company
that the procedure and its related expenses
would be covered prior to undergoing the
procedure.
How long will I be in the hospital?
This
varies from patient to patient. Any post-operative
complications will cause a patient to have an
extended hospital stay. On average, a surgery
with no complications can warrant a stay between
two to seven days. Patients can usually return
to work six weeks after surgery (sometimes sooner),
but should not do any heavy lifting or heavy
manual labor for an extended period of time.
How much weight can I expect to loose?
Again,
each person’s weight loss
progress is different. On average, a weight
loss of approximately 30 percent of starting
weight or two-thirds of your excess weight
is expected. The most weight loss is usually
seen in the first few months after surgery.
Weight loss usually continues for about
12 to 18 months after surgery. Healthy eating
habits and exercise are critical for continued
success.
Are there side effects?
Side effects vary
and are difficult to predict prior to surgery.
Some people report problems such as diarrhea,
excess gas, and vomiting. Most side effects can
be minimized with changes in the diet. Malnutrition
is rare with the current procedures although
vitamin/mineral supplementation is essential
all patients are required to take specific supplements
for life because the procedure creates changes
in nutrient absorption and restrict volume intake.
Can I get pregnant after weight loss
surgery?
It is very important that you do not
get pregnant for at least two years after any type
of weight loss procedure. You must use two
reliable methods of birth control throughout
this time period. Once your weight has stabilized
and the appropriate months have passes, you
can become pregnant.
It is important, however,
to be monitored closely by an obstetrician
and nutrition expert familiar with your
weight loss surgery. One study at Alvarado Hospital
and Medical Center in San Diego, California
actually found fewer pregnancy related
complications in a post-surgical group when compared
to a control group of pregnant morbidly obese
women.
Are there medications that I must avoid?
Some
medications are not to be used because they may
cause ulcers in your pouch. You should permanently
avoid using any type of non-steroidal anti-inflammatory
drugs also known as “NSAID’s”.
Some specific medications to avoid include:
Advil, aspirin, Excedrin, Motrin, Alieve,
and Ibuprofen. If you are unsure about your
individualized medications or any other medication,
contact the physician that prescribed the
medication and/or your surgeon.
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Post-Op
Diet
Will I only be able to eat tiny amounts
for the rest of my life? Will I be able
to eat regular food?
Initially you
will only be able to eat approximately two
to four tablespoons of food.
The stomach
pouch and small intestine learn how to
work together over a period of months. Many patients
notice a dramatic increase in the amount
of food they can handle comfortably in
the first six to nine months after surgery. This
is normal in most cases. This is the time when
the good habits developed in the first few months
will support further weight loss.
Your diet will be gradually advanced and by
six to eight weeks you should be able to eat “regular” food.
Is it true that some people regain some
of the weight that they lose following
the surgery?
Regaining weight or even minimal
weight loss does and can occur. This is usually
related to consuming high fat and high sugar
foods and eating frequently through out the
day. Weight loss surgery will only help you
lose weight. It is important to follow the
nutritional guidelines as a part of your new
lifestyle. It is best to avoid the following
foods:
- Milk shakes and malt drinks
- Cakes and other pastries
- Fried foods
- Pudding
- Chips and other high fat snack foods
- Soft drinks
- Ice Cream
- Candy
How will I know if I have experienced “dumping
syndrome”? What is the best way
to avoid it?
Dumping syndrome is characterized
by nausea, dizziness, stomach cramps
and severe diarrhea. It is primarily
caused by eating or drinking foods high
in sugar and by eating and drinking at
the same time. It is essential, especially
after gastric bypass surgery, to avoid high
sugar foods and not to drink and eat at the
same time. Even small amounts of concentrated
sugar can cause dumping syndrome. Avoid foods
that have sugar as one of the first three
ingredients. Some other names for sugar
are:
- Sucrose or Glucose
- Corn syrup or Maltose
- Fructose
- Dextrose or Honey
- Mannitol
Does everyone experience dumping syndrome?
Most
people are extremely sensitive to sugar after
their surgery, especially sugar that is added
to foods. After a gastric bypass, foods high
in sugar rapidly enter the small intestine (“dump”).
This can lead to feeling of nausea, dizziness,
sweatiness, heart palpitations, stomach cramps,
and/or diarrhea.
“Dumping syndrome” can
be prevented by avoiding foods with added
sugar and by not eating and drinking at the same
time. “Dumping” tends to decrease
over several months as the porch and small
intestines learn to work better together.
Although dumping is uncomfortable, it is
not dangerous.
How do I get my protein in when I can
eat such a little amount?
Following
your surgery, it is important for healing,
as well as to aid in weight loss that
you consume an adequate amount of protein.
Since you are limited in your food intake,
it is recommended that you consume a low
fat, low sugar, high protein drink (we
will give you several options).
You can
also purchase protein powder and add
it to liquids or mix it to certain
foods. As you are able to tolerate more and
increase the variety in your diet,
you should rely on high protein foods to
help meet the protein goal. The nutrition
team works with each patient to help
them reach their protein goal and to
assist the patient in achieving the
best outcome following surgery.
Do I have to take vitamins and mineral
supplements for the rest of my life?
Yes,
vitamins and minerals supplements are
required to help prevent nutritional deficiencies.
Because of your limited intake and some mal
absorption from the gastric bypass, certain
vitamin and minerals will not be efficiently
absorbed. Most people will require a multivitamin,
calcium, and vitamin B 12 supplement. Other
individual vitamin and mineral supplements
may be needed and will be evaluated on an
individual basis.
Will I lose all of my hair? How do I
keep it from falling out?
Hair loss
after bariatric surgery is, unfortunately,
common. There are a number of reasons why you
may lose hair but it is generally reflective
of poor protein intake. Until the shortened
intestine learns to work effectively,
you will be malabsorbing some nutrients,
including protein. Hair loss tends to
present itself around three to five months
after surgery, but will stop if enough
protein is consumed. Each meal should
focus on protein intake, especially immediately
following surgery. The nutrition team
will help you plan a protein-rich diet.
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