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Preparing for Bariatric Operation

Pre-Op and Post-Op Care

PATIENT SUPPORT

During your bariatric surgery journey, surround yourself with a supportive network of professionals, family, friends, and fellow patients for support and encouragement. This section offers a compilation of resources. When it comes to weight-loss surgery, always remember you’re not alone.

TALKING WITH YOUR PRIMARY CARE PHYSICIAN

For some, obesity can be a lifelong struggle with no amount of healthy eating or exercise resulting in drastic weight loss. For many, weight-loss surgery can help turn their life around and help them start living again. You’ve probably talked with your doctor about your weight before and various health-related issues, especially if you are diabetic.

If you have struggled with losing the excess weight on your own through various weight loss strategies, you and your doctor should discuss the possibility of weight-loss surgery. Your body mass index (BMI) and weight takes its toll on your health, and it’s time you took your future into your own hands. Your doctor is there to support you and help you reach a healthier you with the right weight-loss program.

Talking to your doctor means asking smart questions. Your doctor’s answers and expertise can help you decide if weight-loss surgery is right for you. Some guiding questions follow and will help you begin this important discussion.

BE SURE TO KEEP IN MIND THE SELECTION CRITERIA FOR BARIATRIC SURGERY PATIENTS:

  • BMI greater than 40
  • BMI greater than 35 with significant accompanying health issues
  • Well-informed and motivated
  • Failure to achieve weight control with nonsurgical approaches

QUESTIONS TO ASK YOUR PRIMARY CARE PHYSICIAN

  1. Can we talk about weight-loss surgery, and the different types?
  2. Do you think weight-loss surgery is right for me?
  3. Will weight-loss surgery mean I won’t have weight issues any more?
  4. What doctor performs the surgery?
  5. Will my diabetes affect the surgery?
  6. Will being diabetic be affected by the surgery positively or negatively?
  7. Do you see any risks I should be aware of, based on my current health?
  8. Which type of weight-loss surgery would you recommend?

TALKING WITH YOUR FAMILY

Taking a stand against obesity means including your family and loved ones. Talk to them about your weight loss management goals, how you want to live, and why you want to make this change. You’re not in this alone. You need your family by your side for support and encouragement. Your family is an essential part in making the right decision for you.

IMPORTANT TOPICS TO DISCUSS WITH YOUR FAMILY

WHY YOU’RE HAVING WEIGHT-LOSS SURGERY

Family members may not understand the lifelong battle you’ve been fighting with various weight loss strategies. Talk about what the surgery means to you. Remind them of past examples of weight loss programs failing and the importance of bettering your quality of life. Have an open discussion about the commitment you’re willing to make to this now.

Explaining the positive side of weight-loss surgery and behavioral therapy can help family members understand what it means to you and the positive outcomes it can produce. Weight-loss surgery will not only better your quality of life, it can have a positive effect on your loved ones too. In 95% of patients, quality of life was improved. And long-term mortality from diseases related to obesity were reduced by 30-40% in patients.1 Type 2 diabetes, hypertension, dyslipidemia, sleep apnea, asthma, osteoarthritis, and gastroesophageal reflux disease (GERD) are just a few of the issues that can see positive progress with weight-loss surgery.

YOU NEED THEIR SUPPORT

Surround yourself with people who understand and support your goals. Whether it’s a phone call, a visit, or a letter, their help will guide you every step of the way.

Your family may be worried about your overall well-being and whether surgery is the right choice. Explain to your family members that you will not be alone during the process. You will have a complete team at your disposal, which will help you plan a lifetime of care. With your family by your side, you will be that much stronger.

UNDERSTANDING YOUR TEAM

Your choice to begin a new chapter in life is not something you have to face alone. Standing up to obesity is a team effort — before, during, and after the procedure. A team approach fosters a supportive environment in which you can gain knowledge and compassion.

Having experts on your side can help you understand the entire process, as they answer questions and keep you informed of what to expect on your weight loss journey. With the same end goal in mind, your team stands at the ready to help you get there.

YOUR TEAM WILL INCLUDE EXPERIENCED STAFF SUCH AS:

  • Weight loss surgeon
  • Coordinator
  • Dietitian
  • Multidisciplinary team including
    1. Psychologist
    2. Cardiologist
    3. Pulmonologist
    4. Plastic surgeon
    5. Bariatric trained nurses in the operating room and on the patient floor
  • Support groups
  • Former patients

Bariatric surgery is not a quick or simple process. That’s why you will want to assemble a team you can trust throughout the process. These are relationships that extend long after the procedure is complete. These are the individuals who will be by your side. They’re the ones who will enable you to succeed.

PREPARING FOR BARIATRIC SURGERY

In the months leading up to surgery, you will have gathered information, met with experts, evaluated insurance options, and proactively made lifestyle changes to diet and exercise. With the surgery date set, it’s time to make final preparations for surgery.

THE MONTHS LEADING UP TO WEIGHT-LOSS SURGERY

Your future does not start after the surgery. It starts now. Since your BMI is a major deciding factor in weight-loss surgery, diet and exercise are extremely important. Beginning an exercise program before your surgery is the best time for your weight-loss plan. The sooner you begin exercising, the easier it will be after you have surgery. Start by moving more.

  • Walking daily improves your circulation and will help make recovery easier. Grab a pedometer to keep track of your progress.
  • If joint conditions are an issue, look into aquatics programs. Water exercises are great to condition your breathing, but do not put pressure on your joints.

If you’re diabetic, be sure to measure your blood sugar before, during, and after exercising, and always have insulin at your disposal.

Now is also the time to work on your diet and nutrition. Have a discussion with your doctor regarding your weight-loss diet, what weight-loss foods are essential, and how to make sure you are getting the right vitamins and minerals. Discuss weight-loss meals before and after surgery.

Patients are required to stop smoking 8 weeks before surgery, as well as agree to permanently stop smoking after bariatric surgery. Not only is smoking bad for your health, but the complications associated with tobacco and surgery are considerable. Smoking hinders proper lung function and can increase the possibility of anesthetic complications. Smoking can increase your risk of additional complications, like deep vein thrombosis (blood clots in the legs). Smokers who undergo anesthesia are at increased risk for developing cardiopulmonary complications (pulmonary embolism, pneumonia and the collapsing of the tiny air sacs in the lungs) and infection. Besides the well-known risks to the heart and lungs, smoking stimulates stomach acid production, leading to possible ulcer formation. If necessary, speak with your primary care physician about the possibility of a prescription for a smoking cessation aid.

THE WEEKS LEADING UP TO WEIGHT-LOSS SURGERY

Be sure your surgeon is aware of all medicines and herbal supplements you are taking. Avoid all aspirin and aspirin-based medicines for at least 10 days before weight-loss surgery. Even herbal medicines like gingko biloba, garlic, and others should be avoided, as they have blood-thinning properties. Check the label of your multi-vitamin, as many contain herbal supplements. Over-the-counter medication labels should be checked as well, as many contain aspirin. When in doubt, always check with your pharmacist and/or surgeon.

Good hygiene is a must before surgery. Your skin integrity is very important for the operative site. Keep skin clean and dry, especially the few days leading up to surgery. A skin breakdown could possibly cause your bariatric surgery to be delayed.

THE DAY BEFORE WEIGHT-LOSS SURGERY

At your pre-operative appointment, your surgeon will give you specific instructions to follow. You may only drink clear liquids, such as water, coffee, tea, apple juice, grape juice, cranberry juice, bouillon, broth, clear popsicles, clear soda, and gelatin. After midnight the day before surgery, you cannot take anything by mouth except medications approved by the anesthesiologist and surgeon. Your stomach must be completely empty at the start of the procedure to reduce the risk of aspiration.

If you are ill before surgery with a cold, persistent cough, fever, skin breakdown, or any changes in your condition, please notify the surgeon immediately. You will then need to be re-evaluated for surgical readiness. Your bariatric surgeon wants you to be in the best possible shape for anesthesia.

THE DAY OF WEIGHT-LOSS SURGERY

It is recommended that you shower in the morning on the day of surgery. Do not use any moisturizers, creams, lotions, or makeup. Remove jewelry and do not wear nail polish. You may wear dentures, but you will need to remove them just prior to surgery.

When you go to the hospital, just bring the essentials, such as:

  • A small overnight bag with toiletries, including toothbrush, toothpaste, soap, shampoo, and lotion
  • Your eyeglasses and a case, if possible
  • Protective storage case(s) for corrective lenses, dentures, hearing aids, etc.
  • Bathrobe
  • Address and phone numbers of loved ones
  • Lip balm
  • Comfortable, loose-fitting clothes to wear when you go home. Clothes that are easily removed and easy to slip on are best.

Do not bring any jewelry or more than $20 cash. Bring along pictures of family or friends to help you relax and feel more comfortable.

AFTER SURGERY

Typically, bariatric surgery patients can expect to return to work in about 2 to 4 weeks. This schedule can vary from person to person. The time you take from work can depend on a variety of things:

  • The type of work you do
  • Your general state of health
  • Your need to work (i.e., compensation)
  • Your work environment (how badly they need you to return)
  • Your general state of motivation
  • The surgical approach (laparoscopic vs. open)
  • Your energy level

Be aware that you are not just recovering from weight-loss surgery; you are going to be eating very little and losing weight rapidly. You’ll need time to get to know your new digestive system, rest, get proper nutrition, exercise, understand behavioral therapy, and meet with other patients in support group meetings.

Support groups are an integral part of the healing process, physically and emotionally. All patients are encouraged to incorporate a support group into their monthly schedule.

Alcohol can cause gastric irritation and liver damage. During periods of extreme weight loss, the liver becomes especially vulnerable to toxins such as alcohol. You may find that only a couple of sips of wine can give you unusually quick and strong effects of alcohol intolerance. Additionally, alcoholic beverages are high in empty calories and may cause “dumping syndrome.” It is recommended that patients complete a year of abstinence from alcohol after surgery and avoid frequent consumption thereafter.

AFFORDING WEIGHT-LOSS SURGERY

It is essential to understand the financial implications of bariatric surgery and determine how you will ultimately pay for it. The cost of bariatric surgery can range widely, from $12,000 to $35,000, according to the National Institutes of Health.2

For some patients, bariatric surgery is covered by your health insurance plan. However, every insurance policy is different, so it is important to look into the details of your plan to know exactly what is and isn’t covered. Some health insurance companies do not recognize the long-term benefits of surgery for clinically severe obesity. Call your insurance carrier and ask questions to determine what benefits for weight-loss surgery are provided in your policy.

There are no standard coverage policies in the insurance industry for weight-loss surgery at this time. Each policy has its own criteria for coverage. Some of the common insurance requirements are as follows:3

  • Body mass index of 40 or 35 with health-related conditions.
  • Recommendation for surgery from your primary care physician.
  • Psychological evaluation from a licensed psychologist or psychiatrist.
  • Nutritional evaluation from a licensed dietitian or nutritionist.
  • Medical supervision for 3 to 6 months prior to surgery by a physician that includes diet, exercise and nutrition counseling.
  • All previous and current medical records associated with obesity-related conditions.
  • Records showing diet-attempt history including diet programs, journals, or physician-directed diet clinical notes. Some insurance companies require medically documented weight-loss records before approving the surgery.
  • Your insurance company may require or request additional medical records and/or tests prior to approving surgery.

CAREGIVER INFORMATION

If you live with a person who is obese, you play a vital support role. You have likely observed their everyday challenges and struggles with some of life’s basics. While most people enjoy going to the movies, playing with children, and buying new clothes, those struggling with obesity may find these ordinary routines are often challenging undertakings. In gaining a holistic view of obesity, the caregiver has the opportunity to make patients aware of all options to stand up to obesity, including weight-loss surgery.

It’s important for caregivers of obese individuals to understand exactly what they’re going through. The impact of obesity is medical, but also social, physical, psychological, and economic. The psychological impact of obesity can include depression, low self-esteem, social isolation, being uncomfortable in public, intimacy, and decreased libido. Behavioral therapy in combination with bariatric surgery can help patients achieve healthier weights.

THE PHYSICAL IMPACT OF OBESITY CAN INCLUDE DIFFICULTY IN:

  • Going to the movies
  • Sitting on a bus, in a theater, or in a plane seat
  • Using seat belts
  • Fitting through a turnstile
  • Playing with and picking up children
  • Maintaining adequate hygiene
  • Buying clothes

Behavioral therapy for obesity was developed from the dated belief that obesity was the result of eating and exercise habits. Today, researchers realize that body weight is affected by factors other than behavior. The causes of obesity can include genetic, environmental, and behavioral factors. Patients seek surgery because their health conditions are progressive. It’s not only about their appearance.

MEDICAL IMPLICATIONS OF OBESITY:

  • Diabetes
  • Hypertension
  • Lipid disorders
  • Heart disease
  • Asthma
  • Sleep apnea
  • Gallstones
  • Urinary incontinence
  • Reflux
  • Osteoarthritis and gout
  • Cancer (breast, colorectal, prostate, endometrial, etc.)
  • Infertility and menstrual problems

As a caregiver, your knowledge of the complexities of obesity will enable you to provide better care in support of your patient.

REFERENCES

1. Bariatric and Metabolic Institute. Cleveland Clinic. Available from: http://my.clevelandclinic.org/ccf/media/Files/BMI/BMI-Fact-Sheet.pdf?la=en.

2. Information on Bariatric Surgery. U.S. News Health, Duke Medicine. Available from: http://health.usnews.com/health-conditions/heart-health/information-on-bariatric-surgery#7.

3. Criteria based on: Gastrointestinal Surgery for Severe Obesity. NIH Consensus Statement 1991 Mar 25-27;9(1):1-20. Available from: https://consensus.nih.gov/1991/1991gisurgeryobesity084html.htm.

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