Pathway to Surgery

The choice to undergo bariatric surgery is one of the most important decisions of your life. In order to fully understand the process, we have created the following general guide to what you should expect before and after surgery.

Requirements/Qualifying

Bariatric surgery should not be viewed as a weight loss tool exclusively. It is a tool to improve or eliminate the diseases that are caused and exacerbated by obesity. Below, you’ll find a few of several medically accepted criteria for defining morbid obesity and helping you determine whether or not you will qualify for bariatric surgery. In the end it is up to our office and/or your insurance company to decide whether you are a candidate for bariatric surgery. As a rough guide, you may be morbidly obese if you:

• Are more than 100 pounds over your ideal body weight
• Have Body Mass Index (BMI) of over 40, or
• Have a BMI of over 35 and are experiencing significant
  co-morbidities, such as high blood pressure or diabetes.
• Haven’t been able to maintain healthy body weight
  even with medically supervised dieting.
  
  

Insurance and Payment Options

Patients considering bariatric surgery have various options available to them in order to pay for the surgical procedures. Below, we’ll be describing a few of those options. How you pay for bariatric surgery is a highly personal decision, so there is no right or wrong way to pay for surgery. Following are a few options available to you.

• Insurance – check with your insurance provider for policy details
• Self-Pay
• Home Equity
• 3rd Party or Private Loan
  
  

Seminars

One of the first requirements of our bariatric program is your attendance at one of our free seminars. Our office conducts periodic bariatric surgery seminars for people interested in weight loss surgery. These monthly seminars are completely free to you and serve to educate potential, qualified patients on the benefits and risks of the surgical procedures. To register for a seminar, please call (973) 232-2300 or click the following link to visit the seminars page: Bariatric Seminars.

General Pre-Operative Instructions

Once you have decided to undergo bariatric surgery, you’ll have to prep for surgery. Before your scheduled surgical procedure, please follow these instructions:

• Seven days before surgery, stop taking all blood thinners.
• The Day before Surgery, Nothing to eat or drink after midnight.
• Pre-Operative Preparation for Bariatric Surgery:
  • Drink only clear liquids and
  • Take one bottle of Miralax at 2pm
• 8:00 a.m. The Day before Surgery: Reglan (Metocloperamide) 10 mg by mouth
• 10:00 a.m. The Day before Surgery: Start Halflytely Bowel Prep Kit
• 1:00 p.m. The Day before Surgery: 1 gram Neomycin Sulfate; 1 gram Erythromycin Base orally
• 2:00 p.m. The Day before Surgery: 1 gram Neomycin Sulfate; 1 gram Erythromycin Base; 10mg Reglan (Metocloperamide) orally
• 8:00 p.m. The Day before Surgery: 10mg Reglan (Metocloperamide) by mouth
• 11:00 p.m. The Day before Surgery: 1 gram Neomycin Sulfate; 1 gram Erythromycin Base; 10mg Reglan (Metocloperamide) orally.
• After Midnight the Night before Surgery: Take nothing by mouth
• 6:00 a.m. Morning of Surgery: Take your usual oral medications with a sip of water
• Fleet Enema: Give yourself a Fleet Enema about an hour before leaving your home for the hospital the morning of surgery if instructed by your surgeon.
  
  

Post-Op Guide for Surgical Patients

Going Home

You will be going home to recover after surgery. Your doctor or nurse will give you post-op instructions to follow. Please follow them carefully as they will help you learn how to care for yourself and heal faster. Whether you have been an inpatient (staying in the hospital after surgery) or outpatient (going home the same day of surgery), your doctor will decide when you are ready to go home. Before you go, your doctor or nurse will answer any questions you may have about home care. You will need a family member or friend to listen to these instructions with you, drive you home and help with your recovery.

Good post-op care helps you heal quickly and safely. It is important to:

• Follow all instructions and guidelines you are given
• Know how to care for your incision and control your pain
• Know the signs of problems after surgery
• Know when to call your surgeon

For Your Comfort

You may have pain after surgery. Pain medication will help you feel better and you’ll heal more quickly. Ask your doctor about other ways to control pain, such as heat, ice and relaxation techniques. Follow any instructions your doctor or nurse has given to you.

Pain medication helps you move around more comfortably. Take it only as directed, before pain becomes severe. Don’t take it more or less often than you have been instructed. Taking it before bedtime may help you sleep. Always take this, or any medication, as directed.

• Don’t drink alcohol while on pain medication.
• Don’t drive or use heavy machinery or power tools.
• Ask your doctor before taking other medications, herbs or vitamins.
• Pain medication may cause constipation. Avoid laxatives unless they have been prescribed for you. Instead, increase your fluids and fiber. Tell your surgeon if you have stomach pain, nausea, skin rash, itching or hives.

Caring for Your Incision

After surgery, you may be sent home with a dressing over your incision and may have steri-strips to keep it clean and dry. You may also have a tube or drain in place. Most are easy to care for.

Dressings are usually left untouched for 24-48 hours. After that period of time you may remove the outer dressing, leaving the steri-strips in place. You will then be able to shower with the steri-strips in place. They will stay on until you are seen by your doctor. If you have a tube or drain in place, keep it clean and dry. If a tube comes out, don’t panic and don’t try to replace it, but do call your surgeon.

A slightly red, swollen incision is ok – so is some bleeding or discharge. But, if redness, bleeding, pain or swelling increases, if the incision smells bad or is warm to the touch, you may have an infection. If you notice any of these signs, gently press a clean dressing or cloth against your incision and call your surgeon. Fever can also signal infection, so take your temperature twice a day. Call your surgeon if your temperature stays at about 101° F. Call the surgeon if you have numbness of your fingers or if your toes look bluish.

Eating the Right Foods

At first, you may only want liquids (tea, soda, flavored gelatin or clear soup). When you are ready, go on to soft foods like mashed potatoes or applesauce. Then try high-protein solid foods like beans, yogurt, fish or chicken. Tell your doctor if you have food allergies or special food needs.

It’s normal to lose fluids during surgery. Drinking liquids helps you feel better and balances your body’s chemicals. Drink 6 to 8 glasses of water a day (6-8 ounces each), unless you’ve been told not to. Watch for dark yellow urine (a sign that you may not be getting enough fluids).

Try foods that are easy to digest, like clear soup, toast, crackers, ginger ale and gelatin. Avoid fatty foods that stay in your stomach a long time. Eat small amounts more often. And drink bubbly liquids to help you burp.

Call your surgeon if you still have nausea, vomiting or diarrhea 12 hours after surgery.

Exercise / Becoming More Active

After surgery, you’re likely to feel tired. So get plenty of rest to give your body time to heal. Slowly increase your level of activity and exercise. Follow your surgeon’s advice about deep breathing, coughing, driving and other activities. Long-term, exercise will supplement a new diet and successful surgery to maximize weight loss safely.

Breathing and Coughing

To help clear your lungs and prevent pneumonia, you may be shown how to deep-breathe and cough after surgery.

• If you were sent home with a spirometer, use it as you have been shown.
• After minor surgery, breathe deeply and cough regularly for 1 to 2 days.
• After major surgery, breathe deeply and cough regularly
  until the pain from your incision is gone.
• Support your incision with a pillow when you cough.
• To avoid lung problems, don’t smoke.

Get Moving

Walking speeds healing. So get up and walk around as much as you can. Stand up slowly so you don’t get dizzy. And get plenty of rest, so you don’t become worn out. Ask your surgeon when it’s safe to get back to more activity. Don’t drive in a car until your surgeon says it’s okay. Return to exercise slowly so that you don’t become overtired or harm your surgical site.

Call Your Surgeon If

• Your incision opens up (cover it with a clean dressing or cloth).
• Your incision becomes swollen, stays red or smells bad.
• You have increased pain or soreness after moving.
• Your temperature is above 101° F.

Follow Up Care

Successful surgery includes follow-up care. Your surgeon needs to check your healing and see that you’re recovering safely. Ask when to return for your first follow-up visit and whom to call to make an appointment. Also ask when you will have your stitches, staples, tubes or drains removed.

If you’ve been taking medications for diabetes, heart disease or some other condition, ask your doctor about taking them while you recover. This can help you avoid side effects.

Returning to Work

When you are able return to work depends on your surgery and the type of work you do. Your surgeon will decide when you can return to work. Often, it’s four to six weeks after major surgery and a few days after minor surgery. You may still be tired, so take frequent breaks during your workday and rest when you go home. Remember, in your work environment you may be tempted to stray from your new diet. It is important that you stick to your regimen as prescribed by our office.

Support

Our support groups are conducted on a monthly basis and provide a place for those who have undergone bariatric surgery a place to meet and discuss their various personal and professional issues. Bariatric surgery, for example, will not immediately resolve existing emotional issues or heal the years of damage that morbid obesity might have inflicted. This is something that is discussed at our support groups. For more information click the following link: Support Groups.