Frequently Asked Questions
These general answers are compiled from patients who have had WLS. Your experiences may vary.
What types of
weight-loss surgeries (“WLS”) do Dr. Waits and Dr. Macik perform?
What steps
do I take to get approved?
What if I my
insurance company denies coverage of the procedure?
What is the
preoperative procedure?
What
happens the day of the operation?
What sort of
tubes will I have in my body after the surgery?
Will I be able
to get out of the bed on my own?
When will
the tubes be removed?
Will
removal of the tubes hurt?
How soon
after surgery will I be up and around?
What
about postoperative blood clots?
How soon
after surgery will I be able to eat?
Will I be able
to eat out at a restaurant after surgery?
How soon
after surgery can I have a carbonated beverage?
How soon
after surgery will I be able to exercise?
But I’ve
never been one to exercise anyway – why should I start now?
Will my diet
be restricted after surgery?
What’s this
I hear about not drinking water when eating?
How can I
increase protein intake with such a tiny stomach?
What is the
“dumping” syndrome?
Will I need
someone to care for me at home?
How
soon following surgery will I be able to drive?
For how long
after surgery will I need to be off work?
Will I need
to be on any special medications once I’m discharged?
What about
my current preoperative medications – will I be able to take them after the
surgery?
Will I have to
avoid certain medications?
What can I do
to assure the weight stays off?
Will the
weight loss continue at the same pace?
What
about having a baby after this surgery?
I’ve
heard patients talk about having postoperative diarrhea or constipation. Is
this normal?
How long
will I have to see the surgeon for follow-up after surgery?
What are the
chances I will get an incisional hernia?
Will I need
plastic surgery on down the line?
What are
some things I can do to insure that I keep the weight off and that I don’t get
discouraged?
The
Roux-en-Y-en-Y gastric bypass. This
procedure combines the restrictive effect of a small pouch with malabsorption
of food bypassing the duodenum.
Deficiencies in iron, folic acid, and calcium can be controlled by
vitamin and calcium supplements. This
procedure is recommended for patients addicted to sweets.
The
vertical banded gastroplasty. This
procedure involves surgically partitioning the upper stomach with staples,
forming a small pouch. This reduced
stomach volume results in the patient feeling “full” after eating smaller
portions, effectively restricting caloric intake. Back to Top
After
your initial consultation with the doctor, and after you both decides which
procedure would work best for you, you’ll most likely be required to see a
pulmonologist (to evaluate your lungs) and a cardiologist (to evaluate your
heart) to determine your ability to tolerate surgery. (This is the usual procedure for ANYONE having ANY type of major
surgery.) Some insurance companies even
require you to have a psychiatric evaluation, but this varies. If you do need a psychiatric evaluation, the
doctor will provide a referral for you.
After your evaluations, Karen will send a letter to your insurance
company requesting approval. It can
take six to eight weeks to hear from an insurance company concerning
approval. PLEASE DO NOT CALL THE OFFICE INQUIRING WHETHER OR NOT YOU’VE BEEN
APPROVED BY YOUR INSURANCE COMPANY.
The reason for this is that the doctors’ office is very, very, VERY
busy, and repeatedly calling the office to inquire concerning insurance
approval just slows them down. (The office
staff greatly appreciates your help in this particular matter.) Karen will let you know immediately
once she hears from the insurance company.
If approved, Karen will then contact all the folks who will be assisting
with your surgery and make arrangements for the earliest possible date when
your surgery can be done; of course, because of the volume of the surgical
schedule, this date could be as far away as a few months. Back to Top
Then
you may choose to write a letter of appeal to your insurance company; and if
that doesn’t get results you might choose to retain the services of an
attorney. One attorney, who has
actually had weight loss surgery, specializes in getting people approved by
their insurance companies for weight loss surgery. His name is Walter Lindstrom, Jr. He is located in California, and can be reached online at
www.obesitylaw.com. If you contact
him, he’ll send to you a packet of information concerning the services he
provides. Back to Top
About
a week before surgery you’ll be required to go to the hospital and have your preoperative
blood work done. In addition, you’ll be
meeting with a member of the anesthesiology team to discuss your anesthesia,
and answer any questions you might have.
This entire visit usually takes two to three hours. Back to Top
You’ll
arrive at the hospital a couple of hours before surgery and be escorted to the
preoperative area, where an IV line will be inserted, and the nurse will give
you a gown and socks to wear.
Afterwards, the anesthesia team will come and take you to the area where
the epidural catheter will be inserted into your back. For most patients, there’s no pain involved
with the insertion of the epidural.
Then you’ll be wheeled into the operating room, laid down on the
surgical table, and a mask will be placed over your face. The next thing you’ll probably remember is
someone wheeling you into your hospital room post surgery. Back to Top
When
you wake up, you’ll notice that you’ll have a Foley catheter inserted into your
bladder (which is painless), a nasogastric tube inserted through your nose and
into your new little pouch (also painless), a drain at the base of your
incision (which is painless), an IV stand with a bag of fluids next to your bed
and attached to your intravenous line into your hand, and an epidural apparatus
next to your bed that is connected to the epidural catheter in your back and
which is keeping you pain free. You’ll
be able to regulate the amount of epidural pain medication you receive. Back to Top
Though
you’ll be in a Bariatric bed (a bed for obese patients which raises to a
sitting position) you’ll have tubes attached to every imaginable part of your
body, and will need the assistance of a nurse for approximately the first 48
hours. Back to Top
Before
you leave the hospital. Back to Top
Most
likely it will not. Removal of all
those tubes is generally painless because of the epidural anesthesia. The nurse will pull out the nasogastric tube
the first postoperative morning, the Foley catheter will come out after that,
the incisional drain will be removed the day after that, and then the epidural
catheter will come out the day before you leave. After the epidural comes out, you’ll be put on oral liquid pain
medication, and once your pain is controlled and you’ve had a bowel movement
you can go home. Back to Top
The
nurses are required to have you up walking around the night of your surgery,
even though it’s probably just to the door of your room. The nurses will help you with this until you
get all your tubes out. Each time you
go for a walk (about every four hours) try to take a few more steps. Before you know it you’ll be walking on your
own 10-12 times a day all around the floor out of sheer boredom. Remember – the more often you walk, the
faster you’ll be discharged home. Back
to Top
When
you awaken from surgery you’ll notice that there are plastic things wrapped
around your legs that alternately expand and contract. (How annoying is that?!!!) This simulates movement in your legs, and
keeps you from getting a blood clot.
Once the nurses see that you’re up walking on your own regularly, these
things will be removed. Back to Top
You
won’t be allowed to have anything by mouth (even water) until the next morning
after your nasogastric tube is removed; however, if you beg nicely (haha) the
nurses will let you rinse your mouth out with water and spit it out just to get
rid of that yucky taste. As for eating,
most patients are not even hungry for at least the first few days. However, once you are able to eat,
you will only eat items on the “white sheet ” for the first month. Remember the
following words during the first month– IF
IT’S NOT ON THE WHITE SHEET, DON’T EAT IT. Nancy or your doctor will advance a more comprehensive diet
later. (Oh yes, a hospital nutritionist
will visit you before you leave the hospital, but just remember to initially
adhere to WHITE SHEET foods.) Back to Top
Of
course; just remember that if you’re in the first postoperative month you’ll
need to stick to WHITE SHEET food or whatever Nancy has indicated you can
have. When you’re in a restaurant, just
be sensible and select foods you know you can tolerate, unless you’re willing
to risk barfing in the presence of complete strangers. Back to Top
3
months. Back to Top
From
the moment you arrive home you’ll need to walk every couple of hours to prevent
blood clots and to regain your strength… walk around the house… then walk to
the driveway… then walk to the end of your driveway… walk down the street… add
a few steps each and every time, and before you know it in a week or so you’ll
be going around the block. Get used to
exercising REGULARLY. When the doctors
allow, increase your exercise to include walking in a pool, as Dr. Waits has
said that 30 minutes spent walking in a pool equals one and one-half hours of
walking on a treadmill. Exercising is
MOST DEFINITELY a significant part of insuring success after surgery. Back
to Top
Do
you want to regain all your weight back, or what? J Tips
for developing an exercise plan include (a) finding an exercise partner; (b)
join an exercise club or class; (c) listen to your favorite motivational music
as you exercise; (d) be creative – try mall walking, aerobics, swimming or
dancing; (e) take your dog for a walk every day; (f) get comfortable –wear
comfortable workout clothing; and (g) park 15 minutes from your workplace and
walk the rest of the way to work, or walk during your lunch break. Remember – THE MORE YOU EAT THE MORE YOU
HAVE TO MOVE! J Back to Top
Yes. For the first month, you will be required to
adhere to the WHITE SHEET, a copy of which will be provided by the office on
your preoperative visit. This is a TRIED
AND TRUE list of foods, which your little pouch will be able to handle that
first month after surgery. Remember –
if it’s not on the white sheet; don’t eat it until Nancy or the doctor says
it’s okay. Those who do not follow this white sheet are guaranteed to
barf their brains out, and believe those people who’ve had this surgery when
they say that barfing right after this surgery is no picnic. When possible, Nancy (Dr. Waits’ nurse) will
advance your diet to items such as creamed soups (at the end of the first month), and then a few weeks later
you’ll be advanced to items like Lean Cuisine, and such foods. Just remember that your little pouch is
SMALL and can only accommodate a FEW OUNCES.
When you do begin to add new foods, remember to add them ONE AT A TIME
and IN SMALL PORTIONS so that if they don’t stay down you’ll know exactly which
food caused the problem, and can try it again at a later time. Also remember to CHEW YOUR FOOD WELL (until
it is mush) so that it will be digested more easily; this also prevents
blockage of the outlet from your pouch.
This is something you’ll need to do for the rest of your life to keep
from stretching your pouch. Back to Top
That’s
right; avoid drinking liquids thirty minutes prior to a meal and thirty minutes
following a meal; this will help your little pouch not to stretch. Plus, by not filling your little pouch with
liquid, it will allow you to get enough food, and give you that “full”
feeling. Remember – for the first few
months getting enough protein and calcium will become a priority, so it’s
imperative to avoid filling up with liquids around mealtime. You’ll need to take in 64 ounces of water
each day, so be sure you have a container of water nearby wherever you are in
between meals so you can take frequent sips. Back to Top
Probably
a little bit. Most patients who’ve had
the surgery experience a little hair loss at some point during the first six to
eight months; however, once you’re able to take in enough protein, this will
diminish and eventually stop. Back to Top
A
diet, which includes fish, milk, cheese, eggs, cottage cheese, and chicken,
will provide enough protein. Don’t
worry though– a couple of us are even vegetarians and we still get plenty of
protein. J Back to Top
Red
meat is difficult to digest, but some patients are able to tolerate this
beginning a few months post surgery. Fried
foods are often a significant problem though, but let’s face it – fried foods
carry a lot of calories, and the object of this whole process is to eat
healthy, right? Back to Top
In
a nutshell, it’s when after eating something with lots of sugar (like a cookie,
or ice cream, or candy, or cake) you experience lightheadedness, nausea,
dizziness, and just general upper abdominal discomfort so badly that you must
lie down until it passes. This syndrome
occurs because your new pouch has difficulty processing concentrated sweets,
and all the blood from your little head rushes to your little pouch, which
results in the above-mentioned symptoms.
This varies from patient to patient; a very few patients do not
experience this, but most do. Your
tolerance to sugar will increase after a year or so, but let’s face it: DID YOU WANT HAVE THIS SURGERY TO RETURN TO
YOUR OLD EATING HABITS? It’s HEALTHY to
avoid concentrated sweets anyway. J Back to Top
It
would be helpful, but many patients are single, and they’ve had absolutely no
problem caring for themselves from the moment they arrived home. (But a little TLC is always handy, isn’t
it?) Back to Top
You’ll
be able to drive after your stitches and staples are removed, about two weeks
after surgery. Back to Top
It
varies. There have been one or two people
who have returned to work in two weeks; however, most patients return to work
four to six weeks post surgery.
REMEMBER – this is major surgery.
Don’t rush things. Back to Top
You’ll
need to take vitamin B-12 shots, iron, calcium, and chewable multivitamins
(like the Flintstones type) for the rest of your life. Nancy will instruct you on when to begin
these. Some people are put off by the
thought of giving themselves a shot once a month, but ask ANYONE who has had
this surgery what giving a shot is like, and they’ll tell you it’s a piece of
cake (low fat cake, that is!) Back to Top
No
because they don’t get enough of the B-12 into your system. The patients who use the pills and sprays usually
experience low B-12 levels, which is why the doctors prescribe taking B-12 shots.
Back to Top
You
surely can, but if they are large tablets or capsules you may need to cut them
in half or even smaller just to insure that they go down without any
problems. (Most patients who are
preoperatively taking medications for diabetes or hypertension usually come off
them within a year because the combination of weight loss and healthy eating
results in healthy glucose levels and lower blood pressure.) Back to Top
YES! There will be certain medications to avoid
for the rest of your life, because they can harm your pouch. These medications include aspirin, Advil,
ibuprofen, Anacin, Celebrex, Daypro, Fiorinal, Ecotrin, Motrin, Nuprin,
Coumadin, Percodan, Relafen, Talwin, Trilisate, Voltaren, Aleve, Ascriptin,
Bufferin, Empirin, Dolobid, Feldene, Indocin, naproxen, oxyprocin, Lodine, Soma
compound, Persantine, Ticlid and Areva.
(Tylenol CAN be taken for minor pain relief.) For an up-to-date list, see Karen. Back to Top
How
to succeed after the surgery (after all – ask anyone who’s here to have the surgery
AGAIN if you can regain the weight AFTER it’s been done) is all up to you. Weight loss surgery is not a diet, and it’s
not a miracle solution to obesity. It’s
a TOOL which allows you to, right after your surgery, eat less because you have
a tiny stomach, and then gives you time to form a healthy eating
lifestyle. It’s up to YOU to make this
work by adhering to a few common-sense rules:
eat slowly; put your fork down in between bites; chew thoroughly; eat at
the table (not in front of the television); don’t eat when you’re upset;
exercise every day even if it’s just a 30-minute walk every day; avoid
drive-thru as well as fast-food restaurants; eat on a smaller plate using
smaller portions. As Dr. Waits says,
old habits are hard to break, but hundreds of his patients have succeeded using
the aforementioned simple rules to keep their weight down. Back to Top
No. During the first six months to a year you’ll
lose weight quickly; however, as you’re able to add more foods to your diet,
the dramatic speed at which you initially experienced weight loss will slow to
5-10 pounds a month, or maybe even less, depending on your activity level. Another reason it will slow is because if
you’re exercising, you’ll be building muscle, and since muscle weighs more than
fat it will slow a bit; however, you’ll continue to lose inches even though you
might go a few weeks without losing pounds.
Just remember to measure, so you don’t get discouraged. Back to Top
Yes,
you can have a baby after this surgery; however, the doctors recommend that you
wait 2 years before conceiving. The
reason for this is that in the first few months after surgery your food intake
is drastically lower than it will become a year or two following surgery; so it
will take a while for you to increase your intake enough to insure that you are
able to sustain a healthy pregnancy. Back
to Top
Yes. Remember – after you’ve had the surgery your
eating habits change drastically. No
longer are you filling up on unhealthy foods with lots of fat and sugar. You’re eating more fiber and so it follows
that there will be changes in bowel movements, as well. However, after your body adjusts in a few months
this usually returns to normal. Many
patients report having a bowel movement only every two to three days. If your stools are hard, try to include more
high-fiber foods in your diet like a bran cereal, beans, peas, and fresh fruits
and vegetables. These are foods that
will help us maintain regularity AND lose weight! (Very few patients may continue to experience constipation, and
for this Dr. Waits recommends Senokot.) Back
to Top
At
three months, six months, one year, and two years. Back to Top
There
are a few creams/lotions on the market that some patients say helps their
incision fade, but the results vary in each patient. Many patients indicate that those creams/lotions containing
Vitamin E work, and some recommend a new product called “Maderma”, although
it’s very expensive (about $40/tube), but they say it’s well worth it. Back to Top
Pretty
significant if you’re morbidly obese; it’s just the nature of the surgery. Back to Top
Possibly. Most patients who are morbidly obese and in middle
age (over about 40 years old) seek plastic surgery for excess skin that remains
after losing an enormous amount of weight.
Patients who have been morbidly obese for a long time, or who are in
middle age, sometimes have excess skin after weight loss because as we age we
lose elasticity in our skin and after WLS it sometimes sags. One of the most often requested plastic
surgical procedures after WLS is an abdominoplasty (tummy tuck), which can be
performed at the same time as your incisional hernia repair – that is if you
develop an incisional hernia. WLS
patients who are younger often do not seek plastic surgery, but experiences
vary. Back to Top
Come
to the support group meetings. You MUST make maintaining a healthy
weight/lifestyle a priority in your life. This surgery is not a magic bullet – ONLY YOU can keep the weight
off, and as anyone in this group who has kept the weight off will tell you –
coming back each month, being around people who’ve been through what you’ve
been through, listening and sharing what works and what doesn’t work, how their
lifestyle has changed, and just general moral support will go FAR in
helping you succeed in maintaining a healthy weight for the rest of your life. Back to Top
