0 Weight Loss Surgery Care Guide 0 1 Table of Contents Resources 3 Contact Information 3 Appointment Tracking 5 What to Expect on Surgery Day 7 Choosing Bariatric Surgery 10 Building Lifestyle Change 15 Nutrition 18 Meal Plan Progression 20 Liver Shrinking Diet 21 Enhanced Recovery After Surgery (ERAS) 22 Day of Surgery 22 After Surgery 23 Eating Progression 24 Stage 1 25 Stage 2 meal plan 27 Stage 3 meal plan 29 Stage 4 meal plan 31 Stage 5 meal plan 33 Stage 6 meal plan 35 Post-op week 6 and Beyond - Continued Guidance 37 Vitamins and Minerals 39 Protein Supplements 43 Portion Size Guidelines 46 Bariatric Meal Planning 47 Reading the Nutrition Facts Label 48 Identifying Hidden Sugars 49 Label Lingo 50 Food Quality 51 Mindful Eating 53 Hunger Fullness Scale 54 Making Smart Choices When Dining Out 55 Keeping a Food Journal 57 Optimizing Meal Duration 59 Keeping Liquids Separated from Meals 60 Nutrition Goal Worksheet 61 Setting Good Goals 63 Guidance Beyond Nutrition 66 Weight Loss Expectations 68 Medications 69 Physical Activity 71 Sleep 73 Common Concerns After Surgery 74 Dehydration 75 Dumping Syndrome 76 Constipation 77 Addressing Unhealthy Behaviors 79 Building Wellness through Self Awareness 80 Strategies for Lifelong Success 81 Learning More 82 2020 Bariatric Support Group Meetings 83 Updated November 11, 2020 2 Resources Contact Information For medical medical concerns, contact: Saint Joseph Weight Loss Center at Downtown Surgery Specialists 1960 Ogden Street, Suite 550 Denver, CO 80218 Phone 303-318-3240 Fax 303-812-6859 SaintJosephDenverWeightLoss.org Office hours: 8:00 A.M. to 4:30 P.M. If you have a question or concern outside of normal office hours that cannot wait until the office reopens, call and follow the instructions to have an on-call surgeon return your call. For emergencies call 911 or go to the Saint Joseph Hospital Emergency Room Surgeons Dr. Amir Heydari Dr. John Raheb Dr. Emily Speer Dr. Jason Johnson Nurse Coordinator Lisa Swendener, Bariatric Program Coordinator 303-318-3240 [email protected] Dietitians 303-812-6869 Kaylan Crowther, Registered Dietitian Nutritionist [email protected] Kelly Elliot, Registered Dietitian Nutritionist [email protected] Support Group Call 303-318-3240 for dates Second Tuesday of every month 6:00-7:30 p.m. at Midtown Medical Office, Suite 595 Third Tuesday of every month 4:30-6:00 p.m. at Good Samaritan Medical Center, Conference room A Billing and Financial Information: Carmen Hochhausen, Billing and Financial Counselor 303-812-6863 [email protected] Saint Joseph Hospital Financial Counseling 303-812-2655 or 303-812-3478 3 Congratulations! This is the next step on your journey towards better health! This care guide was designed by your weight loss surgery team. Your surgeon, nurses, dietitians, and coordinators are here to assist in your success. They will help you prepare mentally and physically for weight loss surgery. Weight loss surgery is a powerful tool that has helped hundreds of thousands of people lose weight, but it is just that: a tool that you will need to learn to properly yield for lasting results. As you begin your journey, start making a list of questions you have about lifestyle, eating, and activity changes that happen after surgery. Begin to identify your support network for making these changes. Who are your allies in health? Find friends, family, or co-workers who support you in making the decisions necessary for your health. Explore what led up to being overweight and the habits that cause you to overeat. When you begin to unravel this history, it can help you to move forward. We are so excited to be a part of this life-changing opportunity! Just remember, learning to make healthy habits are the key to permanent success. Sincerely, Your Weight Loss Surgery Team at Saint Joseph Weight Loss Center at Downtown Surgery Specialists 4 Appointment Tracking Visit Type Date Initial Visit Behavioral Health Assessment Pre-operative Nutrition class - Units 1&2 Pre-operative Nutrition class - Units 3&4 Surgeon Consultation Primary Care Preoperative exam Surgery Preparation Class Surgery Date Post-operative 1-2 Week Follow-up Post-operative 6 Week Follow-up (Dietitian) Post-operative 4 Month Follow-up Post-operative 6 Month Follow-up Post-operative 9 Month Follow-up Post-operative 1 Year Follow-up After 1 year, plan to visit annually after surgery 5 6 What to Expect on Surgery Day What should I bring on my surgery day? ● Insurance card ● Photo identification ● A form of payment for your post-operative prescriptions ● Wear something loose-fitting and comfortable ● Glasses ● Hearing aids ● Dentures ● Toiletries ● Bi-Pap machine ● Leave any valuables at home ○ Do not wear or bring jewelry or piercings ○ Please remove nail polish or any artificial nails How do I check-in on my surgery day? There is free valet parking available at the main entrance of Saint Joseph Hospital – 1375 E 19th Avenue Denver, CO 80218. Please check-in on the second floor at your scheduled time, typically two hours prior to surgery. 7 Who will I see before my surgery? A team of nurses and doctors will help in your care at the hospital prior to your surgery. You will meet your anesthesiologist to discuss any concerns you have. It is a good idea to prepare a written list of questions, because it is easy to forget if you feel nervous. Your surgeon will also meet with you before surgery. How long does surgery take? Surgery varies for each patient, procedure, and surgeon. Once you have left the preoperative area, your family can expect to wait about two to four hours before being able to visit with you again. How long will I be in the hospital? Although the length of time varies for each patient and procedure, after laparoscopic surgery, most patients stay only one night. If you need more care, this would lengthen your stay. Should I bring my home medications? No. Unless you have been specifically instructed otherwise, you can leave your home medicines at home. 8 9 Choosing Bariatric Surgery Bariatric Surgery Bariatric Surgery encompasses a few different surgical procedures. The three surgeries that are performed at Saint Joseph are Gastric Bypass (Roux-en-Y), Laparoscopic Sleeve Gastrectomy, and Laparoscopic Adjustable Gastric band (Lap Band). Your coverage may allow all of these options, however. Roux‐en‐Y Gastric Bypass Surgery (RYGB) The most commonly performed procedure in the United States, Gastric Bypass has existed in various forms for more than 30 years and has the strongest evidence for long term results. In this open or laparoscopic procedure, a two-tablespoon sized pouch is created from the stomach by dividing the stomach with surgical staples. Part of the small intestine, the jejunum, is attached to the small pouch with a half-inch-sized surgical connection called an anastomosis. This section of the intestine is called the roux limb. The remaining portion of the stomach is bypassed by food and the remaining part of the intestine are linked back to the roux limb, forming a ‘Y’. The small pouch does stretch over time. Most of the weight loss is obtained in the first two years. 10 How Food is Digested After Surgery After surgery, food travels from the mouth, down the throat and into the small pouch that was created, through the anastomosis, into the upper small intestine. Prior to surgery, the stomach worked to grind up foods. The newly created stomach pouch cannot work in this same way, and so thorough chewing is crucial to avoid pain or malabsorption. At the junction of the Y, digestive enzymes from the remainder of the stomach, pancreas, and liver empty into the roux limb. This helps with absorption and prevents symptoms like diarrhea, gas, and discomfort. How Gastric Bypass Surgery Helps You Lose Weight This surgery is both malabsorptive and restrictive. When food stretches the stomach pouch walls, messages of fullness or satiety are sent to the brain. After surgery, a much smaller amount of food is needed to stretch the pouch walls to send the signal of fullness to the brain. After a while, your brain signals to your body to eat smaller amounts of food to feel satisfied. If you eat a larger amount of food, you will feel stuffed, nauseous; you may vomit and even feel pain. This sudden limitation of how much volume you can eat will allow you to learn to make better choices and choose more nourishing, higher quality foods rather than foods that simply fill you up. Our team of dietitians will help you to learn these skills. Gastric bypass also affects hormones produced by the stomach and intestine. One hormone affected is ghrelin, sometimes called the hunger hormone. Ghrelin sends messages of hunger to the brain, increases absorption of calories, and promotes fat storage. The amount of ghrelin produced is greatly reduced after surgery causing a decrease in appetite. Another effect of surgery is a condition called dumping. Before surgery, high-fat and high-sugar processed foods are diluted and begin to be digested in the stomach. The stomach controls the release of this partially digested food into the intestine so not too much is emptied into the intestine at once. After surgery, the valve in the stomach that controls this release is bypassed. This means high-fat or high-sugar foods enter the intestine undiluted at a much faster rate. When this happens, water permeates the intestinal walls to try to dilute these foods. This can cause diarrhea, weakness, sweating, shakiness, sleepiness, and/or a racing heart. This discomfort serves as a strong reinforcement to avoid highly processed foods.