Before Your Weight Loss Surgery Slide 1 of 36 Welcome to the Before Your Weight Loss Surgery presentation. Patients who watch the weight loss surgery presentations know what to expect from surgery and the healing process. So, they are less nervous and are more active in their recovery. These patients have fewer problems and less pain. In other words, the patients that are more informed about their surgery have a more positive, more successful and safer experience. This presentation will help prepare you and any friends or family who watch this with you. Main Menu [No audio] Slide 2 of 36 What you will learn: This presentation will share with you: • How to prepare for surgery • What to expect before surgery • What to expect during your hospital stay • What you can do to reduce the risk of problems and promote healing If you have any questions about your surgery, outcomes or risks other than those covered today, please discuss with your doctor at your appointment. If your doctor’s orders differ from the details given in these slides, please follow your doctor’s orders. Slide 3 of 36 Types of weight loss surgery We currently do 4 types of weight loss surgeries: • With the Vertical Sleeve Gastrectomy (VSG) the surgeon removes most of your stomach, leaving behind a stomach that’s shaped like a banana. • With the Roux-en-Y Gastric Bypass (RYGB) part of the stomach is separated from the rest of the stomach and formed into a smaller pouch. Your intestines are then divided and reconnected into a “Y” shape so that your food bypasses the majority of the stomach and travels directly from the pouch into the small intestines. • With the Laparoscopic Adjustable Gastric Band (LAGB) the surgeon places a small silicone adjustable band around the top part of the stomach to create a small pouch above the band, so that you feel satisfied after eating a smaller amount of food. Before Your Weight Loss Surgery • With the Duodenal Switch (DS) the surgeon removes most of the stomach similar to the vertical sleeve gastrectomy. Then, the surgeon bypasses part of the intestines so you lose your weight because you’re no longer able to absorb food in parts of the intestine. Please read the Making Your Decision handout to learn more about the different types of surgeries. You can also click the link above to watch a video about the surgeries. Slide 4 of 36 Preparing for surgery Your role in recovery begins weeks before your surgery. You will see over the next few slides how to prepare for surgery. You will also learn what other details are important to address before surgery, and what happens the day of surgery. Slide 5 of 36 About your pre-surgery appointments To begin, let’s discuss all of your pre-surgery appointments. These include: • Meeting your surgeon • Weigh-in visit with the nurse • Pre-op dietitian visit • Pre Assessment Clinic (PAC) visit (meeting your anesthesia team) At your first visit with us, we gave you a pre-surgery task list of things to complete before your insurance company will approve the surgery. The pre-surgery task list was customized for you based on your insurance criteria and your medical history. We expected it to take 3 to 6 months to complete everything on this list. Watching this presentation is one of the tasks on the list, as is reading the Making Your Decision handout. You must complete both of these tasks before you make any of your pre-surgery appointments. If you have not already had your first visit or didn’t get a task list, call 612-626-6666 to schedule an appointment. It is also important that you call your insurance and ask if they have an “EXCLUSION” for weight loss surgery AND to call us if your insurance company has an EXCLUSION. If this is the case, the insurance company will NOT pay for the surgery, no matter what information we send to them. Ideally, you should make this call right after your first visit with us. Slide 6 of 36 Pre-surgery appointment: meet the surgeon Before Your Weight Loss Surgery When you’ve completed your pre-surgery task list, call the pre-surgery nurse coordinator to set up your visit with the surgeon. You can also call the pre-surgery nurse coordinator if you have any questions about any of the tasks. • During your visit with the surgeon, you will review the type of surgery you are planning to have done and the surgeon can answer any questions you may have. • After the visit with the surgeon, please call our scheduler for a surgery date and to schedule the rest of your pre-surgery appointments. The scheduler will also be submitting the application to your insurance to obtain “prior authorization” for the weight loss surgery. Slide 7 of 36 Pre-surgery appointment: weigh-in visit About 3 to 4 weeks before your surgery date, you will have a weigh-in visit with the clinic nurse coordinator. The nurse will make sure that you are at your pre- surgery weight loss goal, give you pre-surgery instructions, and help you complete important forms. Losing weight before surgery makes the surgery safer. So, if for any reason you are not at your goal weight at this visit, your surgery date will be postponed until you are at your goal weight. You will need to schedule weigh-in appointments until you meet your goal weight. It is important to plan ahead if you want to fill out a Family Medical Leave Act (FMLA) form and/or disability form. You can discuss these forms with the surgeon and nurse and fill them out as a part of your weigh-in visit. You should also write a health care directive. A health care directive, also called an advanced directive, is a written legal document that states what health care you would want if you could not speak for yourself. It tells your family and care team about your wishes for treatment. Slide 8 of 36 Pre-surgery appointment: pre-op dietitian visit Your insurance company and our program require you to meet with a dietitian once a month for 3 to 6 months before you can have weight loss surgery. This is to help you make healthy choices with diet and exercise and to lose weight before surgery. Surgery is safer when you lose weight beforehand. Once you have met these guidelines and are at your pre-surgery goal weight, you will have one more pre-surgery dietitian visit about 3 to 4 weeks before surgery. At Before Your Weight Loss Surgery this visit, the dietitian will review with you the diet changes you’ll need to make after the surgery. You may be able to have this review at an earlier dietitian visit if you’re already at your pre-surgery goal weight and maintain or continue to lose weight. Your dietitian will keep helping you with diet changes after surgery. You will need to schedule dietitian visits at: 1 week, 1 month, and 1 year after surgery, then once a year after that. You may also schedule other dietitian visits as needed between these times. Slide 9 of 36 Pre-surgery appointment: Pre Assessment Clinic (PAC) At the Pre Assessment Clinic you will meet with the anesthesia team that is in charge of putting you to sleep for surgery. This visit should happen after you’ve met with your surgeon, but within 30 days of your surgery date. When you schedule this visit, let us know if you want to do your pre-op history and physical (often referred to as an H&P) at this visit, or if you’d prefer to do that with your primary care doctor. If you choose to have your primary care doctor do this, it needs to be done before this visit. At this visit, you’ll learn about how the team plans to put you safely to sleep for surgery. You’ll also review any medicines and herbal supplements you currently take. You should learn which medicines you should stop taking before surgery and when to stop them. You should also know which medicines you should continue to take up to the morning of your surgery and how to take them. Your surgeon may also give you special guidelines. We will need to do some lab work after this visit to make sure your body is ready for surgery. We will tell you what needs to be done and help you schedule these visits. Slide 10 of 36 Preparing for surgery Now that we’ve finished talking about your pre-surgery appointments, let’s talk about other important details that need attention. Slide 11 of 36 Other prep: nicotine use As hard as it is to stop smoking or using nicotine (tobacco) products, you must do so both before and after surgery. This is important because nicotine and other harmful chemicals from cigarette smoking can cause many problems during and after surgery, including: Before Your Weight Loss Surgery • Delay healing of the incision (surgical cut) • Increase your chance of infection at your incision • Increase your chance of blood clots • Increase your chance of stomach ulcers • Increase breathing problems after surgery Slide 12 of 36 Other prep: nicotine use (continued) You must stop using all nicotine products at least 6 weeks before surgery. This includes: cigarettes, E-cigarettes, cigars, chewing tobacco, nicotine gum, lozenges, and patches. We will check your nicotine level and cotinine level at our Fairview Outpatient Lab on any day you meet with our team.