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    Bariatric Surgery

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    See also: our Bariatric Surgery for Morbid Obesity services.

    What is Bariatric Surgery?

    Bariatric surgery is the surgical procedure of the stomach and/or intestines to promote weight loss for individuals who are considered morbidly obese. Morbid obesity is defined as individuals who are 100 lbs. over their ideal body weight with a body mass index (BMI) above 40. Bariatric surgery is also an option for individuals with a BMI between 35-40 with additional health problems such as heart disease or diabetes.

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    What to Expect at California Pacific Medical Center

    We are committed to providing you the highest quality of care in a compassionate and supportive environment. This information is designed to reinforce the education already provided to you by your surgeon's office. If anything appears unfamiliar or different from what you expect during your hospitalization and after surgery, please discuss this with your surgeon.

    A Multi-Disciplinary Team Approach to Your Care
    At California Pacific Medical Center, a highly-skilled and experienced clinical staff will aid you in your recovery, and assist in making lifestyle changes necessary after bariatric surgery. Your surgeon leads the team by directing every step of your care. The following is a brief description of other team members' roles:

    • Nursing: Nurses will work with your surgeons and other members of the health care team to provide you with comprehensive and compassionate care. Nursing staff will care for you after your surgery, guide you through your recovery, and provide ongoing education to meet your needs.

    • Bariatric Program Coordinator: A person specialized in the care of the bariatric patient is available if you have any concerns or questions about your hospital stay. The coordinator can be contacted either before surgery or during your hospitalization at (415) 600-6577.

    • Nutritionist: A nutritionist is available to assist you during your hospital stay, if ordered by your surgeon. Nutritionists reinforce the dietary recommendations made by your surgeon. In order to achieve long-term success after your surgery, a nutritionist can educate you on proper nutrition and healthy eating habits.

    • Physical Therapists: Your surgeon may order Physical Therapy (PT) as part of your recovery. Physical Therapists provide assistance if you are having problems with strength and movement after surgery. Physical Therapists work with you to provide education and an individualized home exercise program.

    • Support Services: To assist you in managing your health, there are support services at California Pacific Medical Center. A chaplain is available to provide spiritual support during your hospital stay. Massage therapy can be ordered for you during your recovery. For patients staying a few days, call the Institute for Health and Healing at (415) 600-3939 for information on services offered during your hospital stay.

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    After Surgery

    Starting Your Diet
    Immediately after surgery, you will not be allowed to eat or drink – except for ice chips. Ice chips must be chewed slowly. Once your surgeon feels that you are ready, you will be started on a "thin liquid" diet. This includes broth, sugar-free popsicles, Crystal Light®, sugar-free Jello, and protein drinks. After you tolerate a "thin liquid" diet well, your surgeon will decide when to advance your diet to the next stage.

    Evaluating Your Healing
    Your surgeon may order an Upper Gastrointestinal (GI) X-ray during your hospital stay. This radiology test will provide your surgeon with additional information on your healing after surgery, (presence of GI leak or GI blockage), and when to advance your diet safely.

    Walking is an important part of your recovery. Walking helps prevent blood clots and expands your lungs to prevent pneumonia. Depending on your surgeon's orders, you may be asked to walk on the day of surgery. Your nurse will assist you to make sure you are as comfortable as possible walking after surgery.

    About Your Medications
    Your surgeon will order medications to help reduce any discomfort you may experience after surgery. Common symptoms include incision pain and nausea. Your surgeon will also provide you with pain medication when you go home from the hospital. Many patients are worried about pain after surgery and fearful of how they will feel. You are strongly encouraged to talk to your surgeon about any concerns you may have about your surgical pain prior to your hospitalization. The surgeons, nurses, and pharmacists work as a collaborative team and are highly skilled at managing your pain after surgery.

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    Nutrition Guidelines After Surgery

    Making Progress with Your Diet
    Discuss with your surgeon advancing your diet. Usually, your diet will be advanced on a schedule determined by your surgeon from a "thin liquid" diet, to a "thick liquid" diet, to a "soft foods" diet, and lastly to a "solid foods" diet.

    Drinking Liquids Slowly and Sipping Throughout the Day
    Patients should drink 1-2 quarts (32-64 ounces) of liquids per day. You must drink slowly and sip throughout the day. Do not drink carbonated beverages until your surgeon has approved these beverages. Avoid using straws as these may cause gas build-up.

    Taking in Sufficient Amounts of Protein
    Your diet should be high in protein, and low in fat and sugar. Protein is your primary source of nutrition. Without a sufficient amount of protein intake, you may experience muscle wasting, and complications in the healing of your surgical incision. Limit carbohydrates such as breads and pasta. Refer to your surgeon's nutrition packet regarding the specific amounts recommended for each food group.

    Avoiding Sugar
    Avoid sugar if you have had a bariatric surgery that involved a malabsorption procedure (Roux-en Y or Duodenal Switch). For restrictive bariatric surgeries (Lap-Band or Vertical Gastrectomy) it is strongly recommended that you either avoid or limit sugar from your diet.

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    Important Eating Habits After Surgery

    • Do Not Eat Solid Foods and Drink at the Same Time:

      • You should stop drinking 15 minutes prior to a meal.

      • Do not drink any fluids/liquids until 45 minutes after your meal.
    • Eating Too Much or Too Fast Can Cause Vomiting to Occur: If you find that you are regularly vomiting after meals, contact your surgeon immediately.

    • Stop Eating When You Begin to Feel Full: It is important to listen to your body and recognize when you start to become full. Do not overfill your stomach as that can cause pain and lead to less weight loss over time.

    • Keep a Food Journal: Keeping a record of what you ate and how much you ate is an important tool in learning how to eat after bariatric surgery.

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    Patients who exercise regularly after surgery, and who follow the nutritional guidelines closely are the most successful with their initial weight loss. Regular exercise will also help you to maintain weight loss. Making this one important lifestyle change can be a key factor in your ability to lose weight and keep it off.

    Consult with Your Surgeon Before Starting or Changing Your Exercise Program
    Talk to your surgeon before you start to exercise or if you want to change your exercise program.

    Tips on Starting to Exercise

    • Set realistic goals. Start slowly. Walking is a simple way to start exercising. If walking is difficult, discuss with your surgeon about alternative forms of exercise. You may also want to talk to your surgeon about a Physical Therapy consultation during your hospital stay.

    • If it hurts, stop. Pace yourself. You might be doing too much too fast.

    • Choose activities that you enjoy as you are more likely to follow through and commit to them.
    After Your Surgery You Will Have Lifting Restrictions
    Do not pull, carry, or push anything that is over 20 lbs. Discuss with your surgeon how long these restrictions are in place for you.

    It Is Recommended That You Exercise 30-40 Minutes 3-5 Times Per Week
    For many, this goal may seem out of reach. Don’t let this stop you – just do what you can. Any exercise is better than none.

    Keep an Exercise Journal
    This is a terrific way to track your progress and endurance.

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    Vitamins and Supplements

    • Bariatric surgery patients must commit to taking vitamins and supplements for the rest of their lives. Discuss with your surgeon which vitamins and supplements are best for you and when to take them.

    • Common vitamins and supplements that your surgeon may prescribe are: Multi-vitamins, Iron, Calcium, B-12, ADEK.

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    When to Call Your Surgeon

    Call Your Surgeon Immediately if You Experience Any of the Following Symptoms:

    • If you feel warm or chilled, check your temperature. Call your surgeon with a temperature of 100.5°F or above.

    • Shortness of breath.

    • Chest pain.

    • Inability to tolerate fluids.

    • Persistent nausea and vomiting.

    • Severe diarrhea, constipation, abdominal pain unrelieved by pain medication.

    • Signs of surgical site infection: increased redness, drainage or swelling, and worsening pain.

    • Profound weakness and inability to get out of bed and do simple activities after 2-3 days at home.

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    More Ways to Learn

    Frequently Asked Questions

    Question: When will I be able to eat solid foods?
    Answer: Your surgeon will determine how fast you can advance from liquids to soft/solid foods. Each patient and procedure is slightly different.

    Question: How much pain will I have?
    Answer: Your surgeon will order medications to help reduce any discomfort you may experience after surgery. Common symptoms include incision pain and nausea.

    Question: Is exercise still necessary after bariatric surgery?
    Answer: Yes, exercise is an important and necessary part of your weight loss plan.

    Question: How will I be able to drink so much?
    Answer: Many patients find it a challenge to drink 64 ounces of liquid when their stomach size has been drastically reduced. You must drink slowly and sip throughout the day in order to successfully reach your goals. Remember, "food" items such as Jello, sugar-free popsicles, and your protein drinks all count toward your 64 ounces of liquid.

    Produced by the Center for Patient and Community Education in association with the staff and physicians at California Pacific Medical Center. Date: 8/05

    Funded by: A generous donation from the Mr. and Mrs. Arthur A. Ciocca Foundation.

    Note: This information is not meant to replace any information or personal medical advice which you get directly from your doctor(s). If you have any questions about this information, such as the risks or benefits of the treatment listed, please ask your doctor(s).

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