PATIENT HANDBOOK
BARIATRICS
Table of Contents Welcome to ILAP Meet Dr. Alfred Dawes Why Bariatric Surgery? Are You a Candidate for Weight Loss Surgery? Types of Bariatric Procedures About Minimally-Invasive Bariatric Surgery Gastric Balloon Gastric Sleeve Gastric Bypass Duodenal Switch Your First Visit Your Bariatric Journey Patient Care Coordinator Financial Counselor Internist Psychologist Nutritionist Sleep Study Pre-Op Testing and Additional Referrals Pre-Op Diet Average Time to Surgery Your Surgery Surgery Prep What to bring to the hospital, what to expect during your stay and more Post-Surgery complications (and how to avoid them) Discover Your New Life: After Surgery and Beyond Post-Op Visits Nutrition Vitamin/ Supplement Regimens and why they’re important Exercising after Surgery Resource Guide Contact Us
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BARIATRICS
Edited by Dr. Alfred Dawes | Contributors: Dr. Alfred Dawes | Fern Elise Foster | William Greenwood | Produced by: STUSH Marketing
Welcome to ILAP
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Island Laparoscopy & Medical Care is a premier provider of minimally-invasive bariatric and gynaecological procedures in the English-speaking Caribbean. At the center of our practice is a whole patient approach, which allows us to develop personalized treatment plans for each patient and provide care accordingly. Our staff consists of a team of extensively trained medical practitioners from varying disciplines, all collaborating to provide the delivery of exceptional medical care which will yield optimal results for our patients. In addition to educating our patients on their individual medical conditions and how to obtain the most effective treatments, we also support our patients in developing lifelong skills which will help them live a life in alignment with their long-term health goals.
Welcome to ILAP and get ready to Discover Your New Life!
Meet Dr. Alfred Dawes Dr. Alfred Dawes is a General Surgeon specializing in Bariatrics and Minimally Invasive Surgery. Medicine was natural career choice for Dr. Dawes. As a child, he would accompany his father, Dr. Winston Dawes to work at his medical practice. Thus began a calling to the medical profession, which would see Dr. Dawes graduating from the University of the West Indies, Mona in 2004 with a Bachelor of Medicine and Bachelor of Surgery (MBBS). After training in the Bahamas at the Princess Margaret Hospital for 4 years, and one year at the University Hospital of the West Indies, Mona, Dr. Dawes completed the Doctorate of Medicine for General Surgery in 2011. Following his postgraduate studies, he honed his expertise in Bariatrics with a fellowship in Bariatrics and Minimally Invasive Surgery at the Santa Casa Hospital in Curitiba, Brazil. From 2012-2015 he worked at the Spanish Town Hospital as a Senior Registrar in General Surgery and at present, he is Senior Medical Officer at the Savanna-La-Mar Public General Hospital. In 2017, Dr. Dawes added Fellow of the American College of Surgeons (FACS) to his title. A past president of the Jamaica Medical Doctors Association, Dr. Dawes is a frequent contributor to the Jamaica Gleaner and Jamaica Observer Newspapers, writing articles on Obesity and Health. He has also been featured on TVJ’s Smile Jamaica and is a co-host on RJR’s Doctor’s Orders, always willing to share his advice and expertise. In 2015, co-founded Island Laparoscopy and Medical Care (ILAP) with Dr. Ryan Halsall to provide first class laparoscopic and medical care in Surgical Weight Loss, General Surgery & Gynaecology.
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“I’ve heard it so often with my patients that it’s like a new beginning, a new life. Bariatric surgery is literally a second start for many persons who have been suffering with obesity for years. The enthusiasm that my patients display - it’s similar to a child going out and exploring the world for the very first time. More than anything else, that is what I look forward to, the stories my patients tell me post-op.”
ALFRED DAWES, MBBS DM FACS
Why Bariatric Surgery?
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Obesity is a life-threatening disease. Persons struggling with severe obesity often have a number of life-threatening conditions that greatly increase their risk of dying. There are several physical and psychological conditions that obesity can cause. You may well recognise some of the following symptoms from your own personal struggle with obesity, including: Type 2 Diabetes Obstructive sleep apnea High cholesterol Joint disease
High blood pressure, or hypertension Liver Disease Asthma Certain types of cancer
This is more than just weight loss surgery - it’s chronic disease treatment surgery, it’s life-saving surgery.You will actually live longer if you do this surgery versus choosing a non-operative method. DR. ALFRED DAWES
It is safe The benefits of bariatric surgery far outweigh the risks. Its increasing popularity as a solution for obesity has lead to a vast array of studies showcasing the safety of bariatric procedures, with patients having a 99.9% survival rate. Complications after surgery are experienced by as few as 1 in 10 patients, and the majority of even those tend to be minor. The truth is, persons with obesity are significantly more likely to die from complications due to obesity-related conditions than weight loss surgery itself. In fact, bariatric surgery has gotten so safe that the risks of major complications approach that of removing your gallbladder. RISK COMPARISON Remaning Obese
Bariatric Surgery
99.9% Survival
2nd leading causes of premature death.
Low Risk
Studies have shown that patients who underwent bariatric surgery found major long-lasting benefits to their health and quality of life. When compared with patients who did not have surgery, bariatric patients fared far better physically, socially, and emotionally. Patients rated themselves as much healthier and were less likely to report problems with pain, well-being, mobility, anxiety, and other symptoms which can contribute to the difficulty of leading a normal life.
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It works One of the biggest misconceptions is that bariatrics is the easy way out. Many assume that it is an extreme measure that produces a “quick fix” to obesity, and that if persons just diet and exercise they can lose all the weight they want to. Nothing could be further from the truth. Weight loss is a lot more complicated than you may have been lead to believe. Our bodies have a genetically determined “set-point”; a range of weight that our brains are hardwired to keep us within. If you’ve ever struggled with losing some weight, only to gain it back (and then some!), you will have experienced set-point theory in action. RESULTS OF WEIGHT LOSS SURGERY % Weight Loss
60% 90%
Excess Weight Loss Ranges From 60% - 90%
TIME
Obese persons losing weight with diet and exercise alone must fight an uphill battle against hormonal changes, increased appetite and decreased metabolism...all of which are the direct result of the brain fighting to keep the set-point intact. As you lose weight, your metabolic rate slows down to match your food intake. This explains why you will stop losing weight after being initially successful on a diet. As you come off your diet, your metabolic rate does not necessarily go back to normal. You are essentially consuming extra calories and the weight comes back and may even increase post dieting. Bariatric surgery not only creates physical restriction enabling drastically reduced food intake, but actually impacts upon your brain chemistry to recalibrate your body’s set-point. For an overwhelming majority of patients, this results in a significantly better outcome than diet and exercise can achieve
Are you a candidate for surgery? Persons with a Body Mass Index (BMI) of 35 or above could well be ideal candidates for surgery. If you’re unaware of your BMI, there are various tools available online which can calculate this for you quickly and easily. One such tool is available at smartbmicalculator.com “Simply put, once you hit a high enough body mass index, 100 or so pounds overweight, you have maybe a 5 to 10% chance of losing weight and keeping it off in the long term, with diet and exercise alone. With bariatric surgery your chances of success are the reverse. About 90% of persons lose the weight and keep it off at 10 years with bariatric surgery.” DR. ALFRED DAWES
In your first consultation, Dr. Dawes will take the following factors into consideration to determine if bariatric surgery is right for you. Age Medical & surgical history Body Mass Index (BMI) Other obesity-related conditions eg. hypertension, diabetes Nutritional & psychological profile Lifestyle and ambitions regarding the type of procedure
“If you have hypertension, diabetes, high cholesterol... you are either going to be on medication for the rest of your life, or you can choose to do bariatric surgery. The surgery offers the best chance of being cured of these diseases completely. In the worst case, it offers vast improvement in these conditions with a decrease in the need for medications.” DR. ALFRED DAWES
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OBESITY MEDICAL COMPLICATIONS OBESITY STATISTICS IN JAMAICA Obesity rates among adults moved from 45 percent in 2002 to 54 per cent in 2008, and 60 percent in 2016.
IDIOPATHIC INTERCRANIAL HYPERTENSION
CATARACTS
CORONARY HEART DISEASE
PULMONARY DISEASE
Two out of every three deaths locally are as a result of NCDs (non-communicable diseases) The main causes of death in Jamaica include heart disease, hypertension, cancer, diabetes, stroke, which are all related to obesity.
NON-ALCOHOLIC FATTY LIVER DISEASE
GALL BLADDER DISEASE
Twenty-seven per cent of boys and 33 per cent of girls are overweight, and when we look at it in the global picture, girls over 15 years have the highest rate of obesity.
SKIN
PANCREATITIS
Unhealthy diet was the leading risk factor of the adult disease burden in Jamaica in 2010.
OSTEOARTHRITIS
GYNECOLOGIC ABNORMALITIES
GOUT
chronic venous insufďŹ ciency (poor circulation)
Healthy lifestyle practices, including healthy dietary behaviours, could prevent as much as 80 per cent of the global burden of NCDs. The 2014 Global Status Report on NCDs states that 56 per cent of adults were estimated as being overweight and obese, with 25 percent being classified as obese, 23 per cent had high blood pressure, and 10 per cent had high fasting blood glucose levels.
STATISTICS BY GENDER OBESITY - RELATED CONDITIONS
HYPERTENSION
HEART DISEASE
CANCER
DEMENTIA
PCOS
NAFLD
OVERWEIGHT
OBESE
63%
33%
47.9%
15.7%
LIPID PROBLEMS
T YPE 2 DIABETES
OBESITY IS A MEDICAL CONDITION
1/4 OF CHILDREN IN JA ARE OBESE
REFERENCES DEGREES OF OBESITY
Hibbert, K. (2017). Obese Nation. Jamaica Observer Online Retrieved from http://www.jamaicaobserver.com/news/Obese-nation_93943
Your First Visit
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Your bariatric journey begins with an in-office consultation. You will first meet with our bariatric nurse who will walk you through completing a medical history. This will include the basic questions about your existing conditions and family history, much like those you’ve become accustomed to answering in a visit to your GP. However, there will also be questions about your history of carrying excess weight, eating habits, activity level and previous attempts at weight loss. Vital signs such as your current weight and blood pressure will taken. You will then meet with Dr. Dawes who will review your medical history and ask you any pertinent questions, before guiding you through the weight loss solutions that are available, the benefits and risks associated with each procedure, details of the lifestyle changes you can expect, and finally, recommending the best path for you to discover your new life
TIP: Got questions? Now is the time to ask! There is a wealth of information available on each of the procedures provided by ILAP. Make note of your questions and bring it with you to your first visit so our team can address whatever concerns you may have.
OUR GOALS FOR EVERY NEW PATIENT To provide you with information you need on the bariatric options available To be sure you have realistic expectations To ensure you are fully informed and comfortable with the chosen bariatric procedure To help you to understand that you are the most important part of the formula for weight loss We want you to make the best decision on the weight loss path that is right for you!
Types of Weight Loss Surgery In line with ILAP’s commitment to providing cutting-edge, first-class care options for our patients, all bariatric procedures are performed laparoscopically. Laparoscopy is a minimally-invasive procedure which uses tiny incisions (approximately 0.5–1.5 cm) instead of larger “open” surgical incisions. These leave either a small scar or no scar at all. BENEFITS OF LAPAROSCOPY
Shorter hospital stays, if hospitalisation is required.
Less pain
Less Hernias
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Faster recovery and return to normal activities
More cosmetically appealing due to smaller scars
Less likelihood of developing adhesions (internal scar tissue)
Less bleeding
Laparoscopic Surgery in action
OPEN SURGERY The surgeon makes a large incision to reach your organs.
LAPAROSCOPY
Surgery in done through a few small incisions, Using long, thin instruments and a tiny camera.
The following procedures are offered at ILAP: The Gastric Balloon The gastric balloon is a silicon balloon that is inserted into the stomach. The balloon fills the stomach partially, which provides the patient a feeling of fullness. It’s a very simple, speedy, and non-surgical procedure which is undertaken under moderate sedation. No incisions are made and the entire insertion and removal are done through the mouth. The whole process will take between 30-40 minutes to complete. The gastric balloon is more widely available to patients as the guidelines aren’t quite as strict as the ones for gastric bypass, or sleeve gastrectomy. A gastric balloon can be left in the stomach for up to 6 months, which provides an ample amount of time for the patient to get into the habit of eating smaller portions. As such, patients often choose this as a first step before heading to surgical intervention. Statistics show, that, on average, there is three times as much weight loss achieved in comparison to dieting and exercising alone, and because there is no invasive surgery, the balloon can be easily removed.
Balloon inside stomach Duodenum
Stomach
“This is the choice for persons who are overweight, but not necessarily obese. With the balloon you can lose about 40-50lbs in a six month period. At ILAP, we consider it more of a tool, as it will be a part of a nutritional programme tailored for you, in order for you to lose weight, and to continue to lose weight long after we remove the balloon. It’s more of a “kickstarter” for your lifestyle changes.” DR. ALFRED DAWES
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The Gastric Sleeve The vertical sleeve gastrectomy, or gastric sleeve, sees the removal of around 75% of the stomach itself. As the portion of the stomach removed is the part that expands when you eat and is also responsible for producing the hunger hormone “ghrelin”, the impact of the surgery is further heightened. This leads to patients feeling very little hunger, feeling full much sooner after eating, and improving (sometimes curing completely) obesity-related conditions like hypertension, diabetes and joint pain. At ILAP, our patients have lost 70 - 100% of excess weight with the gastric sleeve. Individual results may vary. The length of this surgical procedure is typically 90 minutes. Once surgery has been completed, your stomach will function much as it did before; the major difference being that you will ingest significantly smaller portions. Patients will generally spend less operative and post-operative time in the hospital than with bypass surgeries.
Stomach Duodenum
Removed partition of stomach
“This is currently the most popular procedure both at ILAP and worldwide. Your stomach is roughly the size of a banana afterwards and you can have up to 4 oz. of food at a time. This is a small amount, but you won’t get hungry and you will receive enough nutrients once you stick to your eating plan.” Dr. Alfred Dawes
The Gastric Bypass Probably the most well-known bariatric procedure, the gastric bypass is a surgical procedure that consists of two components. First, Dr Dawes creates a small pouch in the upper stomach by dividing the stomach into two parts. This results in both restriction of food intake, as well as lower absorption of the food that is ingested. The operative time for this surgery is generally 2-3 hours.Our ILAP patients see 80%-100% of excess weight lost with this procedure. Patients will generally see rather dramatic weight loss in quick time, and many continue to shed the pounds for up to two years after surgery, losing up to 80% of their excess weight on average. You will require regular follow-ups with the nutritionist to ensure you’re getting all your vitamins and minerals. The internist, along with Dr. Dawes, will see you periodically to ensure there are no deficiencies. Gastric bypass surgery is generally recommended for very obese patients with a BMI over 45 or diabetics.
Pouch
Duodenum
Stomach
“Gastric Bypass is excellent for persons who have diabetes. The cure rate approaches 90% in some cases.” DR. ALFRED DAWES
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The Duodenal Switch The duodenal switch is similar in effect to the gastric bypass, in that it utilizes both restriction and malabsorption to effect weight loss. First, the stomach is reduced in a manner similar to the sleeve gastrectomy. The first two segments of the small intestine, the duodenum and the jejunum, are then bypassed, with the new tubal stomach being connected directly to the very last portion of the small intestine. Up to ¾ of the small intestine is bypassed, significantly reducing nutrient absorption. The duodenal switch is most often performed in two separate surgeries. This method offers the greatest likelihood of long-term, dramatic weight loss with patients being able to lose greater than 90% of excess weight on average. Patients undergoing this procedure must strictly adhere to their prescribed diet and supplement as the risk of malnourishment due to nutrient deficiencies is much greater than other bariatric procedures. As such, this procedure is usually performed as a revision to a previous bariatric surgical intervention or with patients who have an extremely high BMI (over 55).
Stomach
Duodenum
Removed partition of stomach Alimentary limb (ileum)
“There are procedures that I do not perform. Many persons ask if Lap-Band is available. Lap-Bands come with a higher complication rate than any other procedure offered. The weight loss is unpredictable, and it’s also much less than the other procedures, so quite frankly I don’t think it’s worth it.” DR. ALFRED DAWES
Your Bariatric Journey
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PATIENT CARE COORDINATOR Your Patient Care Coordinator is your personal guide during your bariatric journey. They will ensure your ILAP experience before, during, and after surgery, goes as smoothly as possible. They will speak with you regarding surgery preparation, answer questions about the procedures, and help to schedule and reschedule appointments for you. After surgery, they will continue to give you much needed support as you navigate the new diet and lifestyle choices that will become a part of your new life. FINANCIAL COUNSELOR Many patients assume that the financial cost of surgery will stand in the way of their success. Our Financial Counselor will walk you through the many options available to you to cover the cost of the procedure, whether you are using insurance or have chosen to pay out-of-pocket. INTERNIST Your internist will be responsible for ensuring that you are physically prepared for undergoing surgery. This includes assessing your medical history and overseeing treatment to address any concerns. New bariatric patients are often learning about obesity-related conditions they have such as hypertension and diabetes for the first time. These must be managed and under control prior to surgery. Based on their findings, the internist may make referrals to additional specialists or require certain tests be performed. The internist will also deal with primary care and help you with postoperative medications throughout your journey. PSYCHOLOGIST The role of a mental health professional when undertaking bariatric surgery is a vital part of your assessment and treatment. You will be given a psychological evaluation prior to your chosen surgery, and provided with support throughout the process. Studies have shown that patients who suffer from depression and/or other psychiatric difficulties may find it harder to lose weight prior to surgery. Your psychologist will also evaluate your strengths and weaknesses in order to best assist your functionality before, during, and after surgery. This is more than a surgical procedure. It's a lifestyle change and the psychologist is there to help to prepare your mind and support you through your new lifestyle.
NUTRITIONIST You will require very careful assessment and guidance to sustain weight loss and provide essential nutrients in order to prepare for your new life. Your nutritionist can be the difference between moderate and great success once surgery is complete. They will guide and inform you as to how best fuel your body for optimal results. SLEEP STUDY Obstructive Sleep Apnea (OSA) is a common issue amongst patients suffering from obesity. Studies have shown that the issue is either often overlooked or completely undiagnosed. A sleep apnea test may be required before you go into surgery, as you'll be under anaesthetic and it is critical that you aren't restricted in your breathing. Obstructive Sleep Apnea can worsen certain illnesses, including type-2 diabetes, high blood pressure, heart disease, depression, and strokes, to name a few. It can also make it harder for you to lose weight, with its impact on cortisol, a hormone which can cause weight gain when elevated. Regular post-surgery follow-ups will be done for you if you suffer from obesity-related OSA. PRE-OP TESTING AND ADDITIONAL REFERRALS Each patient’s bariatric journey is unique. Your pre-operative testing is an essential part of your journey to your new life. At a minimum, you will require: Basic blood tests ECG and a stress echocardiogram to assess your heart function Upper GI Endoscopy to determine the function of your upper gastrointestinal tract
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WHEN NECESSARY, DR. DAWES OR OTHER MEMBERS OF OUR BARIATRIC TEAM, MAY REQUIRE ONE OR MORE OF THE FOLLOWING: Chest X-Ray
Cardiology consultation
Orthopaedic consultation
Pulmonary consultation
Haematology/oncology consultation
Gastroenterology consultation
Endocrinology consultation PRE-OP DIET A certain amount of preoperative weight loss is important in order to lessen any chances of complications for your scheduled surgery. Weight loss prior to surgery can reduce risks of co-morbidities, operating time, as well as recovery time. In the months leading up to surgery, our nutritionist will play a key role in ensuring that you are given a diet plan that will be successful for you and works within your lifestyle. Two weeks prior to surgery you will be placed on a liquid diet. This has proven to be effective way of reaching a pre-op weight loss goal. You will be allowed to consume meal replacement drinks (Ensure, Nutrament, Atkins, etc), as well as broths and other clear liquids. You can consume around 1200-1400 calories per day, of which will most likely come from the meal replacement drinks. Be sure to check the labels of any products you buy during this time, and be aware of high fat and high sugar products. AVERAGE TIME TO SURGERY Every patient is different. Your average time to surgery may well be a lot shorter or longer than another patient. Patients have been known to receive a consultation and approval, and be undertaking surgery within three months of their first appointment. Some patients may take up to five or six months, depending on their situation. On top of that, it also depends on you. Again, you are the most important factor in the process. Attending appointments on time and without rescheduling can affect your overall time greatly. You will not be short of assistance and guidance throughout, so don't worry - we will get you where you want to be.
“This is a life-changing procedure, and there are a lot of emotional changes which will take place as well - you are going to be a different person, and we want to ensure that you are properly prepared for this.� Dr. Alfred Dawes
Your Surgery
SURGERY PREP Two weeks prior to surgery, you will meet with your nutritionist to go over the requirements for the preoperative liquid diet as detailed previously. You will also meet with your anaesthesiologist who will clear you for surgery and also answer any questions you may have about going under anaesthesia. If you have been diagnosed with obstructive sleep apnea, you may also be started on CPAP machine therapy at this time.
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WHERE AND WHEN TO CHECK-IN The ILAP team will be in touch with you to confirm your surgery date, as well as details of check-in time and the hospital at which your procedure will be performed. As always, feel free to contact our office with any questions you may have prior to your surgery date. WHAT TO BRING You will be wondering how to prepare for the ‘big day’. Leave non-essentials like nice clothes and jewellery at home. Ensure you carry personal hygiene items such as soap, toothbrush & toothpaste, shampoo, hairbrush, etc. It’s also essential that you bring loose-fitting clothes and comfortable, non-slip slippers. Also bring your prescribed medications, as well as things to keep you occupied and entertained (a fully-charged phone and charger is preferable!). LENGTH OF STAY Your time in the hospital can range between 2-3 days, depending on the type of procedure you decide upon. It’s absolutely normal to be nervous before any type of surgery, but remember you are in safe hands. Dr. Dawes and your patient care coordinator will visit you in hospital and will work along with your nursing team to ensure you are comfortable. AFTER CHECK-IN During the first two to four hours after check-in, you will meet with the anaesthesiologist and Dr. Dawes and get prepped for surgery. The procedure will then be underway and can take between 30 minutes to a couple hours, again dependent on surgery type. AFTER SURGERY After your procedure, you will be monitored carefully to ensure you are responding well. A critical care nurse will be assigned to tend solely to your needs for the first 24 hours following surgery. You will be fully awake within 6 hours but you may still feel drowsy.
RECOVERY After you awake, you will then move onto the recovery stage. Any pain will be managed with medication, and you will start moving around, both in and out of bed. We generally have you taking short walks within 24 hours of surgery. Learning how to get your liquids in will be extremely important, and we will be working with you to formulate the best strategy to ensure you hit your hydration goals. DISCHARGE Upon discharge, you will collect your medications, and go back to the comfort of your home. Ensure you have someone around, whether a friend or family member, in case you need anything. You should make a full recovery between three and six weeks of discharge from the hospital.
TIP: Your recommended fluid intake is 64 oz per day. Don’t worry if you’re unable to hit this target right away, but work towards getting there, sip by sip. Sugar-free flavour enhancers like Crystal Light, Mio, or apple cider vinegar are a great way to help you get your water in.
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Hospital Checklist Hygiene and Toiletry items, including soap, washcloth, toothbrush, toothpaste, mouthwash and deodorant
Gas-X strips or chewables are a tremendous help to ease the gas pains that are common after surgery.
Eyemask and Earplugs can be a lifesaver,particularly if you have trouble sleeping in new environments.
A Cough Pillow. When you cough, laugh or hiccup, you'll be grateful to have this pressed against your sore abdomen post-surgery. Compression undergarments are also very helpful in this regard.
Comfortable Clothing and Non-Slip Slippers. Loose fitting clothing that is easy to take on and off is best.
Feminine Care items.
Lip Balm Prevents against dry chapped lips.
CPAP Machine if it was prescribed to you prior to surgery.
''The decision is not whether or not you want to do surgery. The decision is whether you can commit to the post bariatric surgery healthy lifestyle’’ Dr. Alfred Dawes
Prescribed Medications Be sure to make Dr. Dawes aware of any current medications you are taking. Pills will need to be crushed before consumption.
Entertainment Fully charged cell phone or tablet. Don’t forget your chargers!
Post-Surgery Complications (and how to avoid them)
DEHYDRATION You will become dehydrated if you do not drink enough fluids. This is one of the most common complications after surgery, though one of the most easily preventable. Don’t be fooled, dehydration must be taken seriously or you could end up right back in the hospital. The treatment is simple - your fluid intake will need to be increased. Drinking will be a challenge right after surgery, but commit to taking small sips, one at a time until your recommended fluid intake is reached. TIP: Your recommended fluid intake is 64 oz per day. Don’t worry if you’re unable to hit this target right away, but work towards getting there, sip by sip. Sugar-free flavour enhancers like Crystal Light, Mio, or apple cider vinegar are a great way to help you get your water in. DIFFICULTY SWALLOWING This can be caused by eating too much, too quickly, or not chewing enough. You may find yourself needing to chew your food for longer, and eat much slower than you did before your surgery. Remember, your stomach is still recovering from major surgery, be gentle with it and follow the recommendations of Dr. Dawes and your nutritionist.
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WOUND CARE The small incisions from your laparoscopic surgery will have stitches (sutures) or tape strips (Steri-strips).Tape strips may be removed gently at home (if they have not fallen off) approximately one week after surgery. Soaking the strips with a warm, wet cloth or taking a shower may make the strips easier to remove. If you notice significant pain, swelling or irritation around your incisions, notify your patient care coordinator or our office immediately. DUMPING SYNDROME This happens when food, especially sugars, moves too quickly from the stomach to the small intestine. Various symptoms can occur, like diarrhea, anxiety, nausea, and weakness. This can be treated by diet changes, which will be addressed by your nutritionist. HAIR LOSS This is caused by rapid weight loss, the body’s response to surgery, and/or nutritional deficiencies. It usually resolves itself within three to six months. INTOLERANCE TO CERTAIN FOODS You may find that you can no longer consume the foods you did previous to your surgery. Firstly, to avoid discomfort like indigestion, you can lower the intake of these foods, or better, avoid eating them altogether. DENTAL PROBLEMS You may encounter various issues with your teeth and gum after some types of bariatric surgery. Alert your patient care coordinator who will liaise with your internist and nutritionist to create a customised solution. This can be addressed by altering your vitamin and mineral intake and adjusting your supplements accordingly.
Discover Your New Life: After Surgery and Beyond
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POST-OP VISITS UP TO 12 MONTHS LATER SURGERY FOLLOW UP After the first month, you will need to attend an appointment with Dr. Dawes to review your progress and ensure you are healing well. Dr. Dawes may also order routine blood tests to ensure that your nutrient levels are appropriate and to determine if any adjustments to your supplement routine are necessary. Of course, if you have any concerns or complications prior to this first follow-up appointment, like severe pain, vomiting, fever, increased heart rate, or difficulty breathing, be sure to call your patient care coordinator or our office immediately. NUTRITION FOLLOW UP Follow-up appointments with your nutritionist will also be critical. As many former patients will tell you, the first year after weight loss surgery can define your long-term success. Make the best use of this time to form the nutrition and lifestyle habits that will become a part of your new life! YOUR MENTAL WELL BEING Statistically, most patients will experience much higher self-esteem after weight loss surgery. However, serious cases of depression will require continued treatment, considering many patients suffering from severe obesity often use food for emotional reasons. Some patients may ‘grieve’ the loss of food. We absolutely recognize the psychological aspect of food loss after surgery, and are on-hand to provide high levels of aftercare which may include the use of counselling and if necessary, medication.
HELPFUL HINTS & TIPS Bariatric surgery is a major surgery. Recovery can be difficult. We’re here to ensure that it’s as easy as it possibly can be to obtain Your New Life. Here are some helpful tips for you:
transition you slowly but surely into eating regular foods. Don’t let “head-hunger” allow you to make poor choices. You now have an amazingly effective tool to assist you in having control over your diet, treat it well.
Don’t be afraid to ask for help - you’re obviously very serious about this, as you’ve already made the decision to have surgery. Your patient care coordinator continues to be a resource for you. Ask for help when you need it. Walk. Walk. Keep on walking. Walk as much as you can. You will likely feel muscle pain and sweat a lot. Push through it. Drink, drink. Keep on drinking! Your goal is 64 oz. of fluids per day, one sip at a time.
NO NSAIDS Non-steroidal anti-inflammatory pain medication are a no-no for bariatric patients post-surgery. These drugs (eg. ibuprofen, Aleve and aspirin) can cause stomach ulcers which are particularly of concern for your new stomach. Stick with acetaminophen/paracetamol (eg. Panadol, Tylenol) or the pain medication prescribed by Dr. Dawes.
Use your pre-surgery memories as motivation. Remember the frustration you used to feel about your excess weight. Use it to your advantage. Let it become your superpower instead of your hindrance. Follow your post-op diet. Your new stomach has been through a lot! The post-op diet is specifically designed to both help your stomach heal and also
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Go to support groups - this may be uncomfortable to begin with, but you’ll thank yourself afterwards. The people in these groups will understand what you’re going through 100%. Unless a person has been through weight loss surgery, they cannot truly understand the tumultuous journey that it is. You will be around people who you have something in common with, and you’ll most likely make friends who will strengthen your support system as you discover your new life.
Bariatric Friendly Recipes
Creamy Cauliflower Mash
http://www.eatingwell.com/recipe/248887/ creamy-mashed-cauliflower/
Greek Yogurt Berry Parfait
http://www.myrecipes.com/recipe/greekyogurt-warm-berry-sauce (revised with sugar substitute)
Spaghetti Zoodles with Ground Beef
http://thehealthyfoodie.com/ground-beef-ove r-zoodles/
Cream of Pumpkin Soup
http://jamaicans.com/creampumpkin/ (revised to lower fat content) Check out our Resource Guide for links to More Bariatric Friendly Recipes!
Exercising After Surgery
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Partaking in some physical activity after your surgery helps you to recover much quicker. It will help improve your circulation, reduce the risk of blood clots, promote wound healing and improve your bowel function. During the first week you can start walking. Initially, you can try and take several short walks per day. When you feel ready, you should look to include a variety of exercises into your daily routine that increase your stamina, flexibility and strength. Try to combine aerobic exercises, to reduce your body fat, with weight resistance exercises that will build and strengthen your muscles. A healthy lifestyle incorporating an exercise programme will offer you many benefits including: • Maintaining weight loss • Boosting your metabolism • Reducing your risk of developing heart disease and some types of cancer • Enhancing your self-esteem and confidence • Helping develop and maintain muscle strength, endurance and tone • Promoting joint stability, bone strength and integrity • Aiding your ability to perform daily living activities • Improving your skin elasticity • Elevating your mood, reducing stress and anxiety • Improving your overall health, well-being and mental outlook
Vitamin/ Supplement Regimens and Why They’re Important Whichever bariatric procedure you have chosen, your stomach is now a lot smaller! As a result of restricted food intake, you will need to take vitamin/mineral supplements for the rest of your life in order to ensure adequate intake of nutrients. Patients who have had gastric bypass surgery or duodenal switch procedure may need additional supplements because surgery can cause nutrient malabsorption. Your nutritionist will work with you to find a vitamin/supplement regimen that’s right for you. It may include: CALCIUM CITRATE Chewable or liquid calcium citrate totaling 1,200-1,500 mg daily. The body is only able to absorb 500-600 mg at a time, so splitting the dose is crucial, but it should be taken separately from iron-containing supplements. Calcium Citrate is the preferred form over calcium carbonate; citrate is easier for the body to absorb and utilise. B-COMPLEX Liquid or chewable form with at least 100 mg of thiamine (vitamins b-1). Thiamine is not stored in the body and must be
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consumed daily. It’s essential for the conversion of carbohydrates into energy, and it's necessary for brain and nerve cell function. B-12 1,000 mcg daily of the sublingual form. This form is the most readily absorbed form. Along with the other B vitamins, B-12 helps metabolize carbohydrates, proteins and fats. IRON Chewable is the most tolerable after gastric bypass surgery; vitamin C helps with absorption. A simple blood test can help determine if this trace mineral supplement is necessary, especially for men. TIP: Crush your Pills! Generally, either liquid or chewable vitamins and supplements will be recommended. If you do need to take your supplements or other medication in pill form, be sure to crush it or cut it into six to eight small pieces. You will not be able to manage whole pills as well as you did before surgery, and it can be difficult for the pills to pass through your new gastric system successfully.
Resource Guide www.barilife.com/bariatric-diet-plans.html - A comprehensive guide to post-surgery diets. www.urmc.rochester.edu/highland/bariatric-surgery-center/life-after-surgery/ bariatric-diets.aspx - Helpful site with downloadable PDF diet plans. www.obesityhelp.com - General obesity guide. www.obesitycoverage.com -General Guide to Bariatric Surgery www.meltingmama.net/wls/post-bariatric-weight-loss-surgery-diet-plans-.html Very female-friendly site with interesting and useful content.
www.mybariatricpantry.com- Fun and easy-to-navigate website with lots of tasty recipes. www.bonsecourscommunityhosp.org/bsch/life-after-surgery-faq-weight-loss.a spx - Informative site with lots of info on life after surgery. www.bariatriceating.com/2014/10/low-impact-bariatric-exercises-no-more-ex cuses-just-do-it/ - Focuses on both diet and exercise post-surgery. www.everydayhealth.com/weight-loss-surgery/weight-loss-surgery-exercise.a spx - Exercise-based website, very simple & laid-back feel.
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