Weight Loss Surgery Guide For Roux-en-Y Gastric Bypass and Sleeve Gastrectomy Patients One day for surgery. A lifetime of support. Locations and Post-operative Questions or Urgent Issues Contact Numbers Call our office at 508-273-4900. (Put this number in your cell phone now!) Wareham Office 100 Rosebrook Way If you have an urgent question, do not leave a message. You must speak with Wareham, MA 02571 someone. Wait for the next available attendant or press the Urgent Nurse Line 508-273-4900 option. There is also a Non-Urgent Nurse Line option for questions. Fall River Satellite Office Problems in the First Six Weeks After Surgery 300 Hanover Street Call our officebefore going to the emergency room or your primary care Suite 1 F doctor’s office. In a severe emergency, call 911 right away. Have a friend or Fall River, MA 02720 family member call our office to let us know you are having problems. 508-273-4900 Preventing Readmissions to the Hospital Tobey Hospital We need to work together. 43 High Street Wareham, MA 02571 > Follow diet and medication instructions (some nausea, vomiting and pain 508-295-0880 is not unusual). > Have appropriate help at home when discharged. Charlton Memorial Hospital > Call early if you are having problems. 363 Highland Avenue Fall River, MA 02720 > Same-day and next day appointments are available. Call as early as possible. 508-679-3131 > Outpatient IV and nausea medications will be used if you are having difficulty getting adequate fluids. St. Luke’s Hospital 101 Page Street A bariatric surgeon is always available 24 hours a day, seven days a week. New Bedford, MA 02740 If you call after 5 p.m. or on a weekend, our answering service will contact the Nutrition only surgeon on call. If you do not receive a call back within 15 minutes, call again. See page 50 for more details. This booklet is provided as a guide to your weight loss procedure. It is an educational tool for our patients at Southcoast Health. Table of Contents Contract ............................................2 Program Outline ...............................4 Pre-operative Appointment Checklist ...........................................5 Introduction ......................................6 Preparing for Surgery .......................10 Pre-operative Nutrition .....................14 Vitamin and Mineral Supplements ...24 Post-operative Nutrition ...................26 Your Surgery .....................................40 Life After Surgery ..............................48 Psychological Success ......................56 Exercise and Fitness .........................60 Appendix ..........................................65 Journal ..............................................66 1 Contract | Roux-en-Y, Sleeve Gastrectomy & Adjustable Gastric Band Having elected to undergo Weight Loss Surgery, I agree to the following: 1. I have been informed of my 24 months. I will be seen yearly 8. I agree to avoid pregnancy for 18 personal medical problems, the thereafter for a total of five years to 24 months post-operatively. dangers of morbid obesity and by my healthcare provider at the 9. Behavior modification is an import- the operations available to me. Center for Weight Loss. ant part of weight loss surgery and 2. The dangers and complications > Adjustable Gastric Band patients will enhance the success of weight of surgery have been completely will see the provider every six loss. I understand that it involves explained to my satisfaction, weeks for the first year for band exercise, changes in the types of including the possibility of adjustments then yearly and/or food I eat and liquids I drink, the dying. as needed. number of meals I eat each day and 3. I am voluntarily electing to have 5. If I fail to keep three consecutive how thoroughly I chew my food. this surgery without the coercion appointments and attempts to 10. I realize that my liver may be or deception on the part of the reach me are unsuccessful, sensitive after this surgery and I surgeon or staff. Southcoast has my permission to should stay away from alcohol 4. I realize the importance of lifelong, contact my Primary Care Physician and any drugs that may cause regular, post-operative follow-up. (PCP) at least yearly for information liver damage. regarding my weight loss and 11. I am committed to contacting the > I agree to maintain follow-up medical condition. I understand surgeon and staff should I have a appointments with the program that my follow-up care will then for five years. surgically related medical compli- be provided by my PCP. cation. > I will have blood drawn at three 6. Specific vitamins and mineral months, six months, 12 months, 12. I have read and understood the supplements will be required after Weight Loss Surgery Guide given then yearly and any other time surgery. I will purchase and be my surgeon may deem necessary. to me and I plan to adhere to the committed to taking these supple- guidelines outlined in the guide. > For Roux-en-Y and Sleeve ments daily for the rest of my life. Gastrectomy patients, the sched- 7. I realize the importance of attending uled post-op appointments with monthly support group meetings the surgeon are as follows: one and understand that they are week, six weeks, three months, crucial to my success, especially in six months, nine months, the first year. 12 months, 18 months and I, ________________________________________________________________ have read the above contract. I understand and agree to abide by the terms. Client Signature: _______________________________________________________ Date: ______________________ Witness Signature: _______________________________________________________ Date: ______________________ 2 Appointments Canceling Appointments Appointment Policy If you cannot make your appointments as scheduled, If you have three consecutive no-call and no-show missed please be courteous and call the provider’s office as soon appointments, this may result in a slow down and/or hold as possible and reschedule your appointment. status in our program. Rescheduling appointments Appointment Checklist > Nutrition, Psychology, or any healthcare provider visit We understand it is not easy keeping track of all your at the Center for Weight Loss, call: 508-273-4900 appointments which ready you for your lifestyle changes. We have provided a checklist on page 5. > Pulmonary or cardiac medical clearance schedule change, please call the specific provider you are scheduled to visit. If you are not sure, please call our Center for Weight Loss Navigator for assistance. 3 Program Outline This information is a guide to help you navigate through this program’s process. It will give you a general idea of what to expect and approximately when to expect it. Attendance is mandatory. Please read carefully. Step 1: Attend seminar Step 3: Nutritional evaluation with dietitian Please check with your insurance company to make (2 visits required. Insurances may require more.) sure you have no exclusions for weight loss surgery > Written evaluation and recommendation is generated and find out what criteria your insurance requires and shared with the weight loss surgery team. for approval. Pre-operative weight loss is required. For example: > > Patient and dietitian will develop goals. > Does my insurance plan cover weight loss surgery? A second nutrition appointment will discuss post-op What requirements do I need to meet to be covered > > nutrition, post-op supplements and diet progression by my plan? with patient goals to be reviewed. Approval for Elective Surgery Step 4: Psychological evaluation Insurance companies have up to 30 days to respond to > (1 or 2 visits and workshop required) a request for surgery. We do not schedule surgery until we have an insurance approval. > Two, one-hour visits are required. After evaluation is complete, you will be assigned to a > Some insurances require three to six months of monthly, > documented, supervised weight loss, diet education pre-operative behavior workshop which meets every and exercise. If you have worked with your physician week for three weeks. recently on your weight loss attempts, please bring copies of this documentation to this visit. Step 5: Second office visit with surgeon or nurse practitioner Step 2: First office visit with surgeon > Pre-op testing should be completed before this second > Review your medical history, determine if you qualify office visit. for surgery. > Review progression of goals. > Discuss surgical procedures and answer your > Review questions. questions. > Medical history review and update. > You will be seen by your healthcare provider at your surgeon’s office every six weeks. > Your surgeon may order pre-operative testing and Step 6: Office visit with weight loss surgery medical clearance at this visit with your primary care nurse educator (Group session) physician or a specialist if deemed necessary. > Risks and benefits of surgery will be discussed. > Hospital stay discussed and questions answered. The pre-op tests may include, but are not limited to, Patient’s support person is strongly encouraged to the following: > come to this visit. > Labs > EKG > Medication review. > Abdominal ultrasound > Chest x-ray > Stress test if over the age of 50 Step 7: Pre-Op surgeon visit Last visit before surgery! If you have had any recent (within one year) routine screenings or tests such as a mammogram, pap smear, stress testing or colon cancer screening, please bring a Step 8: Surgery copy of the results to our office. 4 Pre-operative Appointment Checklist Your advocate