Frequently Asked Questions on Weight Loss Surgery
A: Both the The LAP-BAND System and the Gastric Bypass procedure limits food intake. If you feel nauseated or sick on a regular basis, it may mean that you are not chewing your food well enough or that you are not following the diet rules properly. However, it could also mean that there is a problem, so contact your doctor if it persists. Vomiting should be avoided as much as possible as it can cause the reduced stomach to stretch.
A: If a surgery is performed laparoscopically, patients typically spend less than 24 hours in the hospital. It takes most patients about a week to return to work and a month to six weeks to resume exercising. In the case of open surgery or if there are complications, recovery may take longer.
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A: Weight-loss results vary from patient to patient, and the amount of weight you lose depends heavily on your new lifestyle and eating habits. Obesity surgery is not a miracle cure, and the pounds won't come off by themselves. It is very important to set achievable weight-loss goals from the beginning. A weight loss of 2 to 3 pounds a week in the first year after the operation is possible, but one pound a week is more likely. Twelve to eighteen months after the operation, weekly weight loss is usually less. Remember that you should lose weight gradually. Losing weight too quickly creates a health risk and can lead to a number of problems. The main goal is to have weight loss that prevents, improves, or resolves health problems connected with severe obesity.
A: Check-ups with your doctor are a normal and very important part of the LAP-BAND System follow-up. Many surgeons see their patients weekly or biweekly during the first month and every four to twelve weeks for the first year. Adjustments are performed during some of these visits. It is typical for follow-up visits to be scheduled every three to six months during the second and third year, depending on the individual case.
A: The LAP-BAND does not hamper physical activity including aerobics, stretching and strenuous exercise.
A: Adjustments are often carried out in the X-ray department. They are done there so the access port can be clearly seen. When X-rays are used, your reproductive organs should be shielded. Sometimes adjustments can be done in an outpatient clinic or office, and local anesthesia may or may not be needed. A fine needle is passed through the skin into the access port to add or subtract saline. This process most often takes only a few minutes and most patients say it is nearly painless.
A: There are no restrictions based on the access port. It is placed under the skin in the abdominal wall, and once the incisions have healed it should not cause discomfort or limit any physical exercise. The only sensation you may experience from the port occurs when you go in for adjustments. If you feel persistent discomfort in the port area, talk to your doctor.
A: Although the LAP-BAND System is not meant to be removed, it can be, in some cases laparoscopically. Surgeons report that the stomach generally returns to its original shape once the band is removed. After the removal, though, you may soon go back up to your original weight. You may also gain more.
A: That is not always the case. As a rule, plastic surgery will not be considered for at least a year or two after the operation as, some-times the skin will mold itself around the new body tissue. Give the skin the time it needs to adjust before you decide to have more surgery.
A: These procedures make you eat less and feel full in two ways—first by reducing the capacity of your stomach and second by increasing the time it takes food to get through the digestive system. After a small meal, the amount of which varies from person to person, you should feel full. If you follow the nutrition guidelines when you choose your food and then chew it well, you should not feel hungry or deprived. Remember that weight loss surgery is a tool to help you change your eating habits.
A: Becoming pregnant can be easier as you lose weight. Your menstrual cycle may become more regular. It is recommended with either the LAP-BAND System or a gastric bypass procedure, that you wait approximately one year before trying to become pregnant. At this point your body will be more adapted to handle the stress of bearing a child—significant weight will have been lost, making it easier to carry the weight of a baby.
A: Yes. It's possible to not get enough vitamins from three small meals a day. At your regular check-ups, your specialist will evaluate whether you are getting enough vitamin B12, folic acid, and iron. Your surgeon may advise you to take supplements.
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A: You should be able to take prescribed medication, though you may need to use capsules, break big tablets in half or dissolve them in water. Always ask the doctor who prescribes the drugs. Your surgeon may tell you to avoid taking aspirin and other nonsteroidal anti-inflammatory pain relievers because they may irritate the stomach.
A: Order only a small amount of food, such as an appetizer. Eat slowly. Finish at the same time as your table companions. You might want to let your host or hostess know in advance that you cannot eat very much.
A: Alcohol has a high number of calories and breaks down vitamins. An occasional glass of wine or other alcoholic beverage, though, is not considered harmful to weight loss.
A: After your stomach has healed, you may eat most foods that don't cause you discomfort. However, because you can only eat a little, it is important to include foods full of important vitamins and nutrients as advised by your surgeon and/or dietitian. If you eat foods that contain lots of sugar and fat or drink liquids full of "empty" calories, such as milkshakes, the effect of the weight loss surgery will be greatly reduced or even cancelled.
A: There may be some reduction in the volume of your stools, which is normal after a decrease in food intake because you eat less fiber. This should not cause you severe problems. If difficulties do arise, check with your doctor. He or she may suggest you take a mild laxative and drink plenty of water for a while. Your needs will vary, but you should drink at least 6-8 glasses of water a day.
A: LAP-BAND patients are either outpatient or overnight in the hospital. Gastric bypass patients are typically two days in the hospital.
A: The LAP-BAND procedure typically takes about an hour. Gastric bypass typically takes 2-4 hours. The actual length of the operation depends on many different factors.
A: The Lap Band adjustments are done in the office by adding or removing saline to the subcutaneous (under the skin) port. The adjustments take minutes and are described by the patient as essentially painless.
A: On average, people lose between 50–75% of their excess weight at two years. The amount of weight you lose depends on your motivation, how well you adhere to the post-op diet and how much you exercise. Gastric bypass patients tend to lose weight much faster, but both operations (LAP-BAND and gastric bypass) tend to reach the same level of average weight loss after 3-5 years.
A: You can eat normal foods after weight loss surgery, but you simply eat much less. You can go to restaurants, but you will typically order appetizers or eat a portion of an entrée and take the rest of it home. The only special diet after surgery is the first six weeks where you start with liquids and work up to soft solid food.
A: You will need to take a multivitamin with iron every day for the rest of your life. LAP-BAND patients have fewer vitamin deficiencies because there is no malabsorption. Chewable and liquid vitamins are easier for some patients. Gastric bypass patients will need addi-tional supplements for calcium, iron and B12. Bypass patients should have blood work drawn to check vitamin levels every three months for the first year. LAP-BAND patients should have their vitamin levels checked every year for the first few years.
A: Laparoscopic or “minimally invasive” surgery is performed by making tiny incisions in the abdomen and using specialized instru-ments to accomplish surgery with less pain and quicker recovery. A small fiberoptic camera provides the image for the surgeon to operate.
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A: You can eat normal foods in smaller quantities. You will learn to chew your food well. Gastric bypass patients have learned that high-fiber foods can be difficult to pass through their small gastric pouch. LAP-BAND patients have learned that fresh bread and sticky rice are hard to pass. You will learn to eat to the point of feeling full and then stop. Eating too much at once or not chewing well will cause negative side affects that will hopefully reduce the likelihood of improper eating habits again. It will be hard to gulp large quantities of liquids so you will need to drink water throughout the day so you don’t get dehydrated. You will need to concentrate on the number of calories you are eating. Sugar gives you a lot of calories that will need to be burned. You should eat sugar-free foods and use sugar substitutes like Equal and Splenda. Milkshakes are very high in fat and sugar. You don’t have to avoid milkshakes altogether, but drinking six per day will make the operation fail—you won’t lose any weight. You should also drink diet sodas and low-fat milk. Protein is very important. The body needs 60 grams of protein per day. You should eat your protein first, because you can only eat a half of a cup of food for each meal. If you eat a half of a cup of salad, you will not be getting any protein and then will have to play catch-up, which is hard to do when you have such a small stomach. The whole point of weight loss surgery is that you lose weight without feeling starved or deprived.
A: Most patients go back to work about one week after LAP-BAND surgery, and two weeks after gastric bypass surgery.
A: Exercise will help you lose weight. At first, we expect you to walk thirty minutes per day and gradually increase your exercise as you lose weight. The most successful weight loss surgery patients are those that exercise in addition to the caloric restriction provided by surgery. Water aerobics are easier to do for patients with joint pains and arthritis.
A: One of the reasons weight loss surgery is so successful is because the background hunger so typical of dieting goes away. Patients no longer crave food and sometimes, if you can believe it, have to be reminded to eat! A hormone related to hunger, ghrelin, is decreased after weight loss surgery.
A: Some hair loss is typical of weight loss. This means more hair in the brush or shower drain. You do not go bald. Watching your vitamin (esp. zinc & biotin) and protein intake certainly helps reduce this, but all patients that lose a significant amount of weight will experience some hair loss. It will grow back. Hair loss usually occurs during the first year.
A: Once your insurance company approves the surgery, we can typically get it scheduled in approximately one to two weeks. This depends upon how many studies (labs, x-rays, etc.) you need prior to the operation. Sleep studies and echocardiograms can take several weeks to get results. Patients who pay cash and don’t need a lot of studies can get the surgery completed in a short time. The longest time period is waiting to hear back from your insurance company. Sometimes it takes up to six months or longer to get a response.
A: There has been an increase in the number of insurance companies that will cover the LAP-BAND. Other companies will soon follow their lead. Many insurance companies cover the gastric bypass. Call your insurance company and ask them what their policy is regarding weight loss surgery.
A: Some companies take two weeks; some take six months or longer. It varies from one company to another.
A: The restrictive component of weight loss surgery works by filling a small gastric pouch with food that sends a signal to your brain that you are full and to stop eating. If you drink liquid with your meals, it will flush the solid food out of your pouch and will decrease the success. You should stop drinking 15 minutes before you eat and not drink for one hour after you eat.
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A: Not for the first six weeks. They can cause slippage of the LAP-BAND and leaks in gastric bypass patients. After six weeks, they can cause a lot of crampy gas pains, but are less harmful to the surgery. If you let them go flat, you can drink soft drinks.
A: Symptoms of vitamin deficiency can include anemia, neurological alterations, skin changes, and other metabolic abnormalities. These are difficulty to diagnose and may take time to correct. Vitamins, calcium, and iron supplements should be taken for life after weight loss surgery. This is particularly important after gastric bypass.
A: Yes. Some medications will need to be crushed or taken in liquid form early after the surgery due to swelling. Eventually you should be able to take most medications normally. Large tablets, such as adult multivitamins, will need to be cut in half. Extended release or long acting medications, as a general rule, cannot be crushed or cut in two. This will reduce their effectiveness.
A: The LAP-BAND is easily reversible since it does not involve cutting or rearranging your intestines in any way. The gastric bypass is irreversible.Some surgeons write about reversing the gastric byass, but this is a major operation with much higher risks than even a gastric byass. Patients should think of a gastric byass as permanent.