What To Expect When You're Expecting, Weight Loss Surgery

[worm2872 635]

Thanks. It was good to reread this again!!

[jenneliza 257]

Bumping this for those who may have not read it yet. Very Very informative. Thank you

Bump...again... There are lots of new people lately

Sent from my iPad using RNYTalk

[TinyMamiOf3kids 1,280]

Great reading

[snow25 188]

I feel like I just found the Cliff notes to WLS. Thanks for the details of surgery before and after. I need to book mark this one and come back to it. Thank you!

[Shannalee 65]

This is awesome. Great information for a newbie like me.

[JunkinStuff 2]

Thanks for the awesome post! Can't wait to see the additions.

[amcdowell779 70]

Thank you for this post. Will continue to follow and watch for updates!!

[sissy 14]

Thank you so much for this information

[dstollery 290]

First huge update is coming hopefully in the next couple of weeks. It's great to know that you guys are still useing this and it is helpfull.

[Khuff 12]

Awesome. You should write a book or weekly newsletter.

I agree. That was very helpful.

[kristy3k 1,133]

bump for all the new folks... information worth sharing... where are you David????

[trailblazer57 31]

I came up with this because i noticed allot of people have the same questions and why not put it in an easy to read place right? So here you are, The credit for a lot of this info goes to the users of this forum who every day help to make peoples lives better thru kind words and support. This forum has changed my life already and I hope that everyone realizes what a great resource this is. If you like it great, if you want something added post the add and i will edit it accordingly. I'm not a writer so i'm sorry if the grammer is off. =)

What to expect when you’re expecting, weight loss surgery

First welcome to the forums. Your taking a huge step in your health. Both mental and physical. We are a group of people that share your journey. We can help with questions about before and after as well as things that come up along the way. First my name is David. I am an avid board user and will say that this is the best decision that I made. I chose gastric bypass and was not thinking of group. I was going to just do this and everyone else be damned. I later realized that Joining a support group is not about being less of a man or women but more about realizing that this journey is best taken with friends.

You will notice that we call this a journey. A journey is exactly what you will realize you are on. Not just any journey but THE JOURNEY to the new you. This road will be curvy, there will be hills, valleys and what will seem like impassable mountains. With perseverance, and the help of friends you can make it. WLS (weight loss surgery) is not the easy road. If you are a bible person you could compare it to the scripture that talks about narrow is the road leading to salvation. Wide is the road leading to destruction. I use this because it’s fitting for so many of life’s battles but especially here. The road that the journey to WLS is traveled on is narrow. Its hard and it will likely be the hardest thing you have ever done. DLCoggin would say it’s well worth the work and I can’t think of a better way to say it.

First let’s talk about your decision. You have come a long way already if your just starting your WLS journey. Most hospitals require you to attend an informative WLS seminar. These vary in length and are designed to help you understand what you’re getting into and what your surgery is all about. It’s a great time to get to know your procedure, surgeon and staff as well as some of the people close to you who may be starting the same journey. These are usually free and are held fairly frequently. You can check with your local WLS center for dates and times.

Once that is done usually you will speak with your “case worker” or manager. They help to get all your paperwork in line and can usually help you by telling you if you are likely going to be approved or not. For most basic insurance companies they require a BMI >40 or greater than 35 with other medical issues. Some of these include diabetes, sleep apnea, chronic leg/knee pain or even continued skin conditions related to overhanging skin. Remember that your healthcare team is there to help you. Communicate honestly with them and allow them to work for you. The biggest thing you’re going to learn right here is patience. This process is not going to happen overnight.

So now you have all of that done. They tell you psych eval time. I would highly suggest you to do a review of your psych doc online. See what peeps are saying about them. http://www.healthgrades.com/ or www.ratemds.com are two generic ones. Basically you can just Google them. You should know a few things going into your psych eval.

1. Be honest. This is an evaluation to see how well your going to cope with surgery and if you’re ready for this procedure. As bad as you may want it, you may not be ready for it.
   
2. Try to relax. You’re going to talk with your psych doc and they are going to ask you some questions you may not be comfortable with, Such as eating habits, triggers, social status etc.
   

Most psych evals take 1-2 weeks tops to get back to the hospital. After that they will send the info to your insurance company (most of the time). Now here is the hard part. This can take some time, I don’t mean a day or two I mean it could take months. It depends on your insurance and how borderline you are on criteria. Just be patient, don’t allow yourself to get depressed, this is normal. If your denied you can appeal. Again talk to your healthcare manager/team and find out what you should do. They will likely talk to you about doing sleep studies, etc to see if you have other co-morbid factors. If your approved we move on to pre-op

PRE-OP Ok so you made it to pre op. Take a deep breath and refrain from screaming in excitement and anticipation! Pre op will always include blood work. They look at allot of things to include BUN and Creatine (this tests your kidney function) PT and PTT (these are basically clotting factors for your blood PTT stands for partial thromboplastin time, PT stands for Prothrombin Time .) You will likely also be tested for H-Pylori, this is a bacteria that causes issues because it weakens the mucus protective layer in your stomach. The acid then can damage your stomach lining and then ULCERS develop. This can be treated with antibiotics and most physicians will treat you for it prior to surgery. Have no fear though! this should not delay your surgery! Next you get an EKG. this stands for Electrocardiogram. (EKG is the original term used in Germany, ECG and EKG are the same thing, just ECG is the US form.) This takes a look at your heart. I could go off for hours but you would all fall asleep =). The ECG takes 12 pictures or views of your heart to make sure you don’t have any ischemia or rhythm issues prior to surgery. This is fairly painless and for those of you that have never had it done they simply place 10 electrodes (sticky things they attach wires too) to your chest and arms/legs. They have you lie still and that’s it your done. This gets read by a cardiologist and we move on. Some places have you do an Upper GI or an Esophagogastroduodenoscopy (EGD). This looks at the lining of your esophagus, stomach and pylorus and checks for any abnormalities. Your under local anesthesia for this and you will know be aware of or remember the procedure. If you want to know exactly what they are going to do you can check out this YouTube video

I caution that sometimes ignorance is bliss and you must remember that you are out for this procedure =). There are risks associated with any procedure and I would advise you to be informed and discuss these risks with your surgeon. Some doctors require a sleep study. They will monitor you while you sleep and check for apnea while you sleep. this is a painless procedure. Now comes your dietician appointment. BRING A PAD AND PEN. you’re going to need it. You should already at this point know pretty much what your requirements for nutrition are going to be post op. If you don’t your behind the ball and really need to spend some time doing research. The boards area a great place for information about diet requirements and do’s and do not’s. So this is your chance to get a reality check. You’re going to see how big your pouch really is going to be and why everything your reading says such small amounts. This should be your AAAHHAAA! moment. ASK QUESTIONS! do not be shy here, this is your chance with the dietician to sit down and really get an idea of what is what. Ask the questions that you have been thinking about and don’t be shy. I say that so many times because people are shy when they go to the doctor. This is your body, your whole new you! BE INFORMED.

Now, you have a surgery date. Let’s talk about the diet. This is a word we all hate. DIET it is classified as a four letter word and ranks right up there with poop in my book which, don’t worry we will talk about soon . Poop that is. Every surgeon is a little different but one thing remains the same, the pre-op diet will be hard. It may be the hardest thing you have ever done. Post on the boards, whine to your friends, do whatever you need to get thru it. Your almost there, the tunnel is short and the light is bright! I personally was on the reduced calorie diet for 1 month with HIGH Protein. Some surgeons (common) want you to be on a 2 week liquid diet. The big thing to remember is YOU. CAN. DO. IT. Period. You really can and the boards are filled with people telling you that you can and you will. Failure is not an option at this point people! 2 days prior to surgery you will be placed on a clear liquid diet. Remember that clear liquid includes Jell-O. Clear liquid diets include anything that you can see thru when held up to the light. NO YOU CANT PUT A 2000000 CANDLE POWER SPOTLIGHT TO A CHEESEBURGER AND MAKE IT SEE THRU! I tried. You can and should already have your Protein that you can tolerate at this point so before we talk about surgery day and the day before lets go to protein shall we?

PROTEIN – your new best friend (especially if you mix it with water). There are far too many protein mixes out there and the boards do not endorse any specific one. There are however, a few rules when looking at protein. whey protein ISOLATES should be your number 1 ingredient. Basically this is the easiest protein for your body to use and it’s the best for you post op as well as pre op. Go for one with lower calories, < 5 grams of carbs and little filler. Listen, if your reading this now you’re already determined to do this. You have to understand that you HAVE TO HAVE PROTEIN. you will see posts here of real people that aren’t getting protein or fluids and are winding up in the hospital. If you cannot do the protein then stop now. This is not the procedure for you. Yes it’s that important. So spend some money folks. Start buying different protein powders and trying them out. SAVE THE ONES YOU DONT LIKE! your taste buds change post op you may like them after. I found that lots of people like the unjury and I personally go for optimum’s gold standard whey. Taste wise I have not found a better one. They can be spendy but remember your food bill will drop expediential. So you can afford a good protein mix. YOU MUST INGEST protein every day pre and post op. There is a reason for this pre op. Pre-op high protein diets cause your liver to release glycogen stores (for those of us with fatty livers this is GOOD) and thus your liver shrinks. On top of this you are training yourself to drink these daily. You need 60-80 grams of carbs (depending on surgeon some say 100g) per day. Remember that Skim milk has 8.8 per 1 cup so with 2 cups skim milk and 24g of protein you wind up with 31 grams x 2 a day = 62 grams. Doing well especially if your eating the meats you’re supposed to you will easily fall in the 80’s. Are you overwhelmed yet? If so pause here, Take a deep breath and remember you have some time. Research what you’re doing, what you’re going to go thru. You must be informed to be successful. Check out the forums they have GREAT high protein recipes in there!!!! People have gone to crazy lengths to type them out for you! use the resources available to you!!

DAY BEFORE SURGERY – OMG it’s here! ITS HERE!! your excited I bet and if you’re like the majority of the rest of the population your nervous and starving. =) You have your mag citrate? Ok, so if you’re doing your surgery in a hospital away from home get a hotel room and lay claim to the bathroom. You will be in here for 5 ish hours depending on the person. Drink the required amount and await the urination via anus. This is required because it’s safer to operate on a person that has empty bowels and intestines. Now, your done and its 1155. You remember no more liquids after midnight so you drink a little Water and settle in. Try to sleep, you won’t sleep much but try to reflect on how far you have come. It’s been a journey already hasn’t it? From the start of this whole thing you have hoped for this moment. It’s here and your scared. That’s natural. I have a post in these forums about what to do tomorrow if your still very nervous and anxious. Sleep time, tomorrow will be a very exciting day for you.

Day of surgery. Every hospital is different but one thing remains, you’re about to start the next length of your journey. You will be given an IV or 2 depending on hospital policy. An IV provides vascular access that is access to your vein and thus access to your blood stream. It is a piece of plastic called the canula that is inserted into a vein after a slight poke and then left in. This will likely be attached to a Fluid called LR or Lactated Ringers. This is basically saline with a little sugar and other nutrients in it. This gives your body a little extra mmmmffff before surgery. When you meet with your anesthesiologist make sure you discuss with him if your anxious. This is not the time to be manly or womanly or whatever. They have medications to help you. you will placed in pre op holding. Here you will likely get a shot of Coumadin or another anti platelet aggregate. These are you “blood thinners” this is to prevent clots from forming. The main reason for this is that anesthesia causes a very brief period of stasis. This is a concern because some people can form a clot during this brief form of stasis and if that happens a PE can develop (pulmonary emboli) this would be a clot that travels to your lungs. When they wheel you into surgery here is what to expect. . . .

The OR is allot like leaving earth and entering an alien room. Everything is shiny, clean, cold. You will get goose bumps as you feel the cold table and room. There will be allot of people but don’t stress! You have a surgeon sometimes in at this point, scrub nurse, rotating nurse, anesthesiologist and possibly a Physician assistant that assists with surgery. There may or may not be a student in the room. This is your team. They are not aliens wearing masks getting ready to anal probe you!!!!! I only stress that because the drugs are reeeaalllly goood. LOL. Ok so back to reality they are your healthcare team. They are prepared, motivated, trained and here just for you. You’re going to feel some warmth in your arm, this is goooood. this is medication to prep you for intubation. STOP HERE IF YOU DONT WANT TO KNOW WHAT HAPPENS DURING THE START OF YOUR PROCEDURE. Ok so you get the warm fuzzy’s, perhaps you feel a little out there. This is likely some fentanyl and perhaps a little versed. If you see white stuff in your iv line this is milk of Michael, AKA propofol. Fuzzy now, things will go out of focus. You won’t remember anything past this point. Once you’re out you will be given succinocolyn. This is a neuromuscular paralytic. It will help to allow the anesthesiologist to intubate your without your gag reflex. A tube 7.5 or 8.0 for men and 7.0 (average) for women will be inserted to your windpipe (trachea) . DONT freak out about this. YOU WANT THIS! this is the most secure airway you can have. Now the procedure starts. You are catheterized, this means a tube is inserted thru your urethra (where you pee) and into your bladder. This will allow urine to drain. Once the procedure is done your wheeled to the PACU. This is the Post Anesthesia Care Unit. 1 to 2 hours here and your back to your room. You need to blow off the anesthesia, so they will ask you to breathe deeply etc. You likely won’t remember this because of the meds

The first day after surgery is your sleepy day. You will have the affects of anesthesia, some gas pain and perhaps some incision pain. This is a laparoscopic procedure usually so the incision pain should be minimal. You will likely have a PCA pump. Patient Controlled Analgesia pump. This has a button that you press that delivers a small amount of pain medication. There are a few things worth mentioning at this point. First Pain should be well controlled as it can hinder the healing process. So use your PCA! Use your PCA before you shower or get your cath out. Pain is a symptom. Remember this because if after you go home you develop large amounts of pain it is a symptom of something. Back to the day after. . .

So your laying in bed you have ted hose on and likely a foot pump. this keeps your legs and feet moving and blood flow from entering stasis. Remember you foot exercises. Pull your foot back towards your knee then press it like your pushing on a gas pedal. This moves your blood and helps prevent blood clots. The forums are riddled with people that will attest to the power of walking. YOU MUST WALK post operatively. This is not a maybe people you MUST. even if you’re getting up, moving to a window and back its important. It helps with so much stuff but more importantly it helps relieve the pain of gas.

you will have an UPPER GI done, this is to check and make sure everything is going well, swallow study likely will be done. Remember to drink. Just because you have an IV doesn’t mean you get a no drink pass. Remember to ask for an anti-emetic if your nauseated and try to relax!

Once your home you will be weak, remember you just had major surgery and right now you’re still hauling around all that weight and getting minimal nutrition so take it easy!! Do not over do it but you should be walking. Stay off the scale!!! You are going to want to see your results but try to focus less on that and more on getting enough fluids. YOU HAVE TO DRINK! you can’t not drink folks. YOU WILL wind up in the HOSPITAL if you don’t stay hydrated. Lots of things are common post op and we will discuss a few of them here below.

POST OP WOES

1. gas pain – this is the most common pain and most people say walking is the number one reliever of it. 1 member said that putting one are above his head made it go away, the point is whatever you have to do walking is the key.
   
2. Hunger – This is not usually an issue if you have hunger remember to drink your fluids.
   
3. Dehydration – this is your NUMBER 1 ENEMY! you have to stay hydrated people. Signs and symptoms of dehydration include dark colored urine, weakness, fatigue, dizziness, lightheadedness when you stand, difficulty concentrating. As the dehydration progresses guys you can develop SERIOUSE COMPLICATIONS! Your HEART is a sodium potassium pump. that means that as you dehydrate you become sodium and potassium deficient. this can cause dysrythmias (irregular heart rates and rhythms), muscle twitching, contractures of the fingers etc. it’s a big deal people so drink your fluids!
   
4. Blood clot – Ok, so first let me say that as a paramedic this scares the @#$@ out of me. These are NOT to be played with. No reason for paranoia but, if you develop chest pain or shortness of breath then you should be in the ER. chest pain that is typical with PE (pulmonary Emboli) is pinpoint. That is you can point to where it hurts. THIS IS A MEDICAL EMERGENCY. Calling an ambulance in this scenario is NOT A BAD IDEA. The bottom line is, don’t mess around peeps . Don’t be ignorant and think this will go away. YOU NEED MEDICAL ATTENTION NOW not in 5 minutes not in a few days NOW.
   
5. Liquid stools – to some extent this is expected however most people find that after a few weeks they are having normal stools.
   
6. Vomiting – Ok I won’t go into dumping here because that is a paper in and of itself. Vomiting is a symptom. If your vomiting all the time even when drinking Water you should be calling your surgeon. If you vomit blood you should call your surgeon.
   
7. fatigue – this is very common post op and is actually expected. You were told to take 3 weeks off work likely and you should do it. Remember you weigh X still and your getting such a small amount of nutrition that you need to be careful when doing activities that demand allot of calories.
   

Well, I hope this was informative. This is your journey and on behalf of everyone here I want to welcome you to the RNY talk forums. We get a little crazy sometimes, especially the women in the powder room but for EVERY question you could have there is someone that has asked or is wondering too. So post away, from sex to nutrition we are open to talk about it. Everyone that knows me will say this is almost my motto but remember to Advocate for yourself and be informed. This is the new you. It’s your time to shine and we are all here for you. Welcome.

Wow tomorrow start my liquid diet and 1/14/2013 is my surgery date. This was a great narrative....I enjoyed reading it!. You will not have to worry about any depression or therapy for depression because you have worked it out in detail. Great Job, Great journey and God bless.

[kristy3k 1,133]

Bump for all the newbies out there.... best post ever!!!

[hek1127 166]

This was really comprehensive and exactly what I was looking for since I'm just starting this journey. Thanks!

[karlam29 221]

Really nice im starting this whole process and it was really informative thanks!!