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Q1:
Why do blood clots sometimes occur after surgery?
A: Blood clots form because of
pooling of the blood in the large veins in the legs. This occurs when
patients move their legs less, such as either during surgery or when
spending a time in bed recovering after surgery. Stress, such as from
surgery or injury, causes the blood to clot in these pools to clot more
easily. Combine these changes with thickening of the blood that can occur
after surgery due to mild dehydration, and the result is an overall
increased risk of blood clots forming in the legs. Your doctors will use
early ambulation, automatic compression stockings, and blood thinners to
prevent these clots from forming. Be sure to do what you can to help, by
getting up as much as is practical, and by putting your compression
stockings back on when you get back into your hospital bed, and your risk
of forming blood clots will stay low, hopefully just a few percent or less .
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Q2: What if I can't eat a few
days after surgery?
A: It is hard to eat
much 5 days, or even a week or 2 after surgery. Your small stomach pouch,
and the opening between the pouch and your intestine are swollen and
almost closed off. You also are recovering from major surgery, and don't
feel like eating much. Concentrate on taking liquids so you don't become
dehydrated, and eat simple pureed and soft foods as you are able to. The
problem up till now has been too many nutrients. You probably have great
nutritional reserves, and can go for some time without depleting your
stores. As you feel better and the swelling goes down, and you learn what
agrees with you, you will take more. As you begin to take more, try to
lean toward high protein foods and supplements, bearing in mind that some
people can't take dairy products or dairy based supplements. Do let your
doctors know how you are doing, especially if you have diabetes, so that
they can adjust your medicines as your intake goes up and down.
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Q3: What do I do if I want to
eat in a fancy restaurant?
A: The rule of thumb is always eat protein. Most
will gladly grill or roast a piece of chicken, fish or steak. Even if not
mentioned on the menu restaurant's menu most willingly makes substitutions
of permitted vegetables spinach, green beans etc., instead of potatoes or
rice. If the restaurant simply will not prepare a dish which you are
permitted to have order something with fish, poultry or steak and a
separate plate. Take the protein and scrape off the offending sauce,
breading, etc. and place it along with any permissible vegetables on your
"keeper" plate and give the "Fattening Stuff" back to the waiter (you
don't need the temptation to sneak a taste and no-one in your party needs
extra fat or calories). If there is one food you can eat with impunity it
is protein. At the dinner party load up on salad and protein (push the
gravy or sauce to the other side of your dish) and dig in! Although you
may not be following the program 100% it won't be too bad or hurt your
progress that much.
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Q4: Can I eat fast food?
A: Many patients worry about
where they can get meals in fast food chains or restaurants. It is very
easy to get the types of food you need at many of the fast food chains
such as Burger King, Wendy's, or McDonald's. (These are good choices to
make even if you have not had the surgery.) All three offer salads that
are low in calories and fat. Both Wendy's and Burger King offer Chunky
Chicken Salads. Unfortunately, Long John Silver's offers fish and
chicken entree's which are both fine (remember no rice, cole slaw or bread
sticks) and they will be happy to substitute a salad for the starches you
are not permitted to have. Hardee's offers a grilled chicken sandwich,
which will be permissible for lunch if you eat only one slice of bread and
request it without mayonnaise. Arby's offers the only turkey sandwich in
the fast food circuit, which is fine with only 1 slice of the bread. Mrs.
Winner's offers broiled chicken with green beans. Remember the old standby
at any of these fast food places. You can always order a garden salad and
a hamburger pattie with mustard. This is a quick meal that is
available at all the fast food chains.
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Q5: What about exercise?
A: It's important to exercise
while trying to lose weight. Walking is the key. The bike manufacturers
and gym owners would like you to think that heavy exercise is the key,
but, research is recommending less vigorous and stressful physical
activities for those of us who wish to lose or control our weight.
Most patients have adequate amounts of lean body
mass. In many overweight individuals this mass will be very close to or
exceed their ideal weight range. This means that they do not need
additional muscle and need to lose fat.
Remember you
cannot exercise fat and can only
exercise muscle. Our body responds to exercise by increasing muscle size
and thereby increasing lean body mass. Adding additional lean body mass to
an individual who is trying to loose fat undermines the whole process. It
is quite likely that you will gain weight if you exercise extensively.
This will be more pronounced if your protein intake is increased while
dieting.
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Q6: What is a Bariatrician?
A: A Bariatrician is a
licensed physician (Doctor of Medicine [M.D.] or Doctor of Osteopathy
(D.O.) who, as a member of the American Society of Bariatric Physicians
(ASBP), has received special training in bariatric medicine the medical
treatment of overweight and obesity and its associated conditions.
Bariatricians address the obese patient with a comprehensive program of
diet and nutrition, exercise, lifestyle changes and, when indicated, the
prescription of appetite suppressants and other appropriate medications.
(The word bariatric stems from the Greek word barros, which translates as
heavy or large.)
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Q7: How Prevalent is Obesity?
A: Obesity is a chronic,
debilitating and potentially fatal disease that requires treatment by a
physician trained in bariatric medicine. It is marked by an excess
accumulation of body fat sufficient to endanger health. The United States
is currently suffering an obesity epidemic contributing to the premature
death, sickness and suffering of millions of Americans.
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Q8: What about childhood
obesity?
A: Approximately one in five children in the US between the ages of 6 and
17 is overweight. The number of overweight children in the US has more
than doubled in the past 30 years. The number of overweight children (age
6-17) has doubled within three decades. Obesity in children is a chronic
disease that overshadows all others in frequency in the pediatric
population. Changes in the Western lifestyle have led to significant
reductions in energy expenditure of children and have encouraged
"super-sizing" of calorie-dense, high-fat foods and snacks. Physical
inactivity, "junk" food diets (including high calorie soft drinks and
fruit beverages), increased television watching accompanied by snacking,
increased time playing video and computer games all contribute to
increased obesity among the young. When we think of the major problems
facing pediatrics in the next millennium, the disturbing trend toward
obesity has to be among the most serious, with all the adverse health
implications that obesity carries. (Pediatric Alert, March 27, 1997)
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Q9: What are the Health
Implications of Obesity?
A: Obesity has been established as a major risk factor for diabetes,
hypertension, cardiovascular disease and some cancers in both men and
women. Other co morbid conditions include sleep apnea, osteoarthritis,
infertility, idiopathic intracranial hypertension, lower extremity venous
stasis disease, gastro-esophageal reflux and urinary stress incontinence.
Obesity-related medical conditions contribute to 300,000 deaths each year,
second only to smoking as a cause of preventable death.
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Q10: How is a Patients BMI
Related Health Risk Determined?
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No
Obesity |
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BMI
>= 27 kg/m2
(approximately 20% above ideal weight) |
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BMI
>= 30 kg/m2
(approximately 30% above ideal weight) |
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Q11: What happens after the
surgery?
A: After your Gastric Bypass surgery, you will begin to awaken in the
post-op recovery room, in what may seem like just an instant. Many
patients will have little or no recollection of being there, a normal side
effect of the medicine given to you during anesthesia. Ordinarily, your
breathing tube is removed from your throat as you begin awakening —
usually before you are aware of it being there. You will be started on
pain medication by the nurses in recovery as soon as you need it. The IV
line for fluids and medications that was started in the operating room
will remain with you for your entire stay in the hospital and will take
care of your required fluid intake. Although you won't be allowed to drink
water for the next day or so, you will be allowed to suck on ice chips
after the first day if your mouth is dry. About 4 hours after surgery, the
nurses will ask you to sit up again, only this time, you will dangle your
legs off the side of the bed and put your feet on the ground. We check to
see that your vital signs are ok, your pain medication is ok and that you
are recovering normally in preparation for your first walk. The nurses
will get you up again in preparation for your first walk about 5 hours
after surgery. Along with your deep breathing and coughing exercise,
walking is essential to your recovery. For your entire stay in the
hospital, the nurses will get you up and make you walk around the floor
about every 2 hours. As your recovery continues, we monitor your pulse,
your temperature, and your blood count caref ully.
If you are showing good medical progress, we start you on swallows of
water, followed by Jell-O and broth — your meals for the next few days.
Don't worry about finishing your meals. When you feel full or just don't
feel like eating — stop. Depending on the patient, on the second or third
day you will be instructed in preparation for leaving the hospital. If you
are taking fluids well, can tolerate Jell-O and broth, don't have a fever
and are breathing and walking well, we will send you home.
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Q12: What should I eat after surgery?
A: Follow these four simple rules faithfully and the weight will come off
and stay off. Break these rules continually — and long term you will gain
weight. Your surgery is a tool to be used with these four rules and
experience shows that unless you follow them, we cannot predict any weight
loss results. When patients reach a 'plateau' and stop losing weight, it
is usually because they are not following these simple but very important
rules!
Protein first every meal:
Eat the
protein portion of your meal first, very meal! One to three meals per day.
Eating protein helps the body to feel 'full' and sends a signal to stop
eating. Protein is very important to building tissue in the body — muscle,
your organs, your brain — everything is built with proteins. Now, the body
does not need three meals a day, so listen to your hunger cues and don't
worry about the clock. It the beginning - after you can tolerate solid
food - most patients only eat one or two meals a day.
No snacking between meals :
Eating
anything flavorful or containing calories in between meals is considered
snacking. Do not eat between meals at all! If you absolutely have to
snack, the only snack that is acceptable is protein. In the beginning,
turkey jerky is a good protein — and you must work at it a little to eat
it! Later on, after 6 months, beef or venison jerky is acceptable — but
only if you just have to eat something. The main problem with snacking on
flavorful food is that it contains glucose or some other sugar. We feel
good when we eat sugar and when that sugar is gone — one to three hours
later — our brain sends a message to snack again! Snacking actually makes
us hungrier! Do not open the door to snacking. Snacking will slow down or
even stop your weight loss! And depending on how much or how often you
snack, you can actually gain weight! Not good! You can get this big again.
Remember, the surgery has only changed your digestive system and not your
eating habits. Your commitment to a change in lifestyle is the key to
making the surgery work for you for the rest of your life.
Drink water:
Drink water, drink water, drink water! Especially in the beginning, when
you can only tolerate a mouthful at a time, it is so important to
continually sip water all day - and make sure you drink 48 to 64 oz. a day
minimum - that's 2 to 3 quarts per day. Eventually, you will able to drink
2 to 4 oz. at one time. No tea, soda (with or without sugar), coffee, or
juice are allowed. There are a couple of problems with drinking flavorful
liquids in between meals. First and most importantly, it encourages
snacking — not good! Second, flavored drinks with any sugar can cause
dumping — making you very sick!
Exercise:
Exercise every day for at least 30 minutes. Walking is fantastic exercise
and is probably the easiest way to get started exercising. We understand
that in the beginning you may struggle with a simple walk down the hall
and that your energy level can be very low. Your job is to move your body
a little more every day. At 4 to 8 weeks (everyone is different) you will
mostly feel back to normal. After you have been cleared by your physician,
you may begin other forms of exercise. Eventually, incorporating both
aerobic and resistance training into your daily exercise routine will help
you remain healthy - at a healthy weight - for the rest of your life.
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Health
risks involved with morbid obesity
far outweigh the risks involved with surgery.
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