Frequently Asked Questions
We have attempted to address the most common questions concerning the Bariatric Surgery we perform. We have separated those questions into different phases of the process to hopefully allow you to narrow the focus of your search for answers. However, we realize it is impossible to answer every question that you may have so please Contact Us for any question related to Bariatric Surgery for which you have not found an answer. You may also want to refer to our Other Bariatric Resources section to find valuable informative links to other resources available.
How does weight relate to type 2 diabetes?
Carrying extra body fat goes hand and hand with the development of type 2 diabetes. People who are overweight are at much greater risk of developing type 2 diabetes than normal weight individuals. Being overweight puts added pressure on the body's ability to properly control blood sugar using insulin and therefore makes it much more likely for you to develop diabetes. Almost 90% of people with type 2 diabetes are overweight.
What impact do my medical problems have on the decision to do surgery?
Medical problems such as serious heart or lung problems can increase the risk of any major surgery. On the other hand, problems that are related to the patient's weight may also increase the need for surgery. In other words, a variety of medical problems will usually not prevent the surgeon from recommending Weight Loss Surgery if it is otherwise appropriate.
Is there anything I can do to prepare for surgery?
- STOP SMOKING: Smoking has a significant influence on your outcome including the chance of dying around the time of surgery. Everyone knows that smoking creates lung problems, but the unavoidable reality is that a history of smoking also leads to a 5-10 fold increase in the following risks: infection, heart attack, and even Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE).
- Lose weight before surgery: It appears that the body (heart, lungs, etc.) suffers the most from obesity when it is at very heavy weights. Surprisingly, great benefit comes from the loss of 10 or 20 pounds with more loss being even better. We also find that excess weight tends to come out of the abdomen (probably the liver) first; so, just a few pounds can make it much easier for your surgeon to perform the surgical procedure.
- Exercise: Get your heart and lungs in the best possible shape by doing whatever physical exercise you can tolerate. Starting an exercise program before surgery is also the best bet on keeping a regular exercise program following surgery.
- Prepare Mentally: Try to approach the surgery as the beginning of a whole new phase in life. If you approach surgery with thorough education and determination to make the best of the opportunity, the chances of success are very high. Practice the post surgery diet. This will give you a practical idea of what you are getting into, with the side benefit of some weight loss.
- Attend a monthly support group - much can be learned from other patients that the surgeons and staff cannot teach.
What can I do before the appointment to speed up the process of getting ready for surgery?
- Establish a relationship with a primary care physician, if you don't already have one. Work with that physician to get "caught up" on your routine health maintenance testing.
- Discuss the symptoms of Obstructive Sleep Apnea and work with your physician to get this evaluated and treated.
- Initiate contact with your health insurance company to learn about their criteria to cover Weight Loss Surgery.
- Bring any pertinent medical data with you to your appointment to see your surgeon; this would include reports of special tests (echocardiogram, sleep study, etc.) or hospital discharge summary if you have been in the hospital.
- Bring a list of your medications with dose and schedule.
- STOP SMOKING.
What if I have had a previous bariatric surgical procedure and I'm having problems?
The first option is to contact your original surgeon - it is highly preferable for the original surgeon to take care of a surgical problem because he/she is most likely to know the correct solution based on his/her knowledge of your surgical anatomy. If you have relocated too far away from your original surgeon or there is some other reason that it's not reasonable then we may be able to help. We will need to have an operative report from your first operation; it will be up to you to obtain that from your original surgeon's office. We may first want an Upper Gastrointestinal (GI) X-ray or scope performed to see if there's a correctable surgical problem.
What about insurance coverage?
Insurance companies and employers coverage for morbid obesity is constantly changing. We have developed a dedicated staff who will be happy to assist you during the insurance approval process.
If you don't find answers to all your surgical procedure questions then you may locate them in the side by side comparison of the procedures on our How We Can Help page.
What is dumping syndrome?
One key feature that helps control calorie intake after Gastric Bypass is that food leaves the tiny pouch into a section of the small intestine called the jejunum. The jejunum is simply not made to handle concentrated calories, especially refined sugar. The effect of a person consuming concentrated sugar after a gastric bypass (such as ice cream, chocolate candy, or a soda) is a reaction called dumping syndrome that affects the whole body.
During an episode of dumping you may feel palpitations (i.e. heart racing), a sweaty and clammy feeling, cramping abdominal pain, diarrhea, and then a feeling of weakness during which the person simply must lay down for an hour or so until it passes. Dumping syndrome is not dangerous but it feels awful. It is not exactly a side effect in the sense that it works in a beneficial way by steering patients away from that type of food.
Patients with gastric sleeve do not usually have dumping syndrome.
What happens to the lower part of the stomach that is bypassed?
We leave it in place with an intact blood supply so that it remains healthy and unchanged. The lower stomach still contributes to the function of the intestines even though it does not receive or process food it does make Intrinsic factor (necessary to absorb Vitamin B12) and contributes to hormone balance and motility of the gut.
What important digestive functions do people lose when the lower stomach is bypassed?
The bypassed stomach and small intestine do play important roles in the absorption of Iron, Calcium, and Vitamin B12 thus we require the patients to take supplements and we follow blood levels of these and other nutrients for the rest of your life.
What about the staples inside my abdomen? Is it OK in the future to have an MRI test? Will I set off metal detectors in airports?
The first thing to understand about the staples used on the stomach and the intestines is that they are very tiny in comparison to the staples you will have in your skin, or staples you use in the office. Each staple is a tiny piece of stainless steel or titanium. Because the metals (titanium or stainless steel) used are totally inert in the body, people are not allergic to the staples and the staples do not cause any problems in the long run. The staple materials are also non-magnetic which means that they will not be affected by an MRI and they will not set off airport metal detectors.
What should I bring with me to the hospital?
Basic toiletries (e.g. comb, toothbrush, etc.) and gowns are provided by the hospital but most people prefer to bring their own. Choose clothes for the hospital that are easy to put on or take off and that can stand staining by blood or other body fluids. Bring slippers so you can begin walking ASAP after surgery. Other ideas:
- A small fan (room temperature control can be variable)
- Reading material
- Portable music
- Notepad keep track of questions you may have or information you receive
- Skin moisturizing lotion
- Cell phone and/or tablet. Free Wifi is available for patients.
I am so big. Will I have trouble with hospital gowns, hospital beds, etc.?
Upstate has the ability to accommodate extra large patients in terms of wheelchairs, hospital beds, and most equipment. We have gowns that will fit ALL sizes and you are invited to bring your own sleeping clothes as well.
How is pain managed?
We routinely use a Patient Controlled Analgesia (PCA) pump. We usually add a 24 hour course of Ketorolac (a Non-Steroidal Anti-Inflammatory Drug or NSAID). Pain meds (usually Lortab) by mouth are offered beginning on Post-op day 1; the patient uses these to transition off the PCA. A prescription for oral pain medicine will continue after hospital discharge.
What is done to minimize the risk of Deep Vein Thrombosis (DVT)?
Because a DVT often originates on the operating table, we begin therapy before you go to the operating room. We treat patients with sequential leg compression stockings and Heparin (blood thinner). Both of these therapies continue throughout your hospitalization. The third major preventive measure involves getting the patient out of bed as soon as possible after the operation in order to restore normal blood flow in the legs. The nursing staff will ask you to get out of bed and walk in the hall the same day as your surgery.
What is the right amount of exercise after Gastric Bypass?
Many patients are hesitant about exercising after surgery but in reality exercise is an absolutely essential component of success after surgery. Exercise begins on the afternoon of surgery. You will be out of bed and walking. The goal is for the patient to walk further on the next day and progressively further every day after that, including the first few weeks at home.
We usually release the patients from medical restrictions and encourage them to begin exercising regularly after the first post operative office visit which normally occurs within one to two weeks after surgery. Patients are limited only by the level of incision discomfort. Some patients who have severe knee problems may not be able to walk well but almost all can swim or bicycle. Many patients begin with low stress forms of exercise and we encourage them to progress to more vigorous activity when they are able. Sexual activity is okay from two weeks onward, again as dictated by comfort level.
Can I get pregnant after Gastric Bypass surgery?
Yes, but we strongly recommend you wait at least one year after the surgery. Please think about some reliable method of birth control for use in the first year after surgery to avoid the possibility of pregnancy. At approximately one year your body will be fairly stable from a weight and nutrition standpoint. You should be able to carry a baby with no nutritional issues. You should be in contact with your surgeon as you plan for pregnancy
Long Term Outcomes
How much weight should I expect to lose?
Weight loss is very individual. You hold the keys to your own success. The more effort you put in, including things like; working with your new "tool" and adhering to exercise and diet guidelines, the better your results will be. Individual results vary from 50 - 100% of extra body weight loss depending both on the type of surgery and the discipline and determination of the individual. On average, our patients lose 65% of their excess weight with the biggest weight loss occurring within the first year to the first year and a half after surgery.
How can I achieve the best weight loss?
The best results are seen in patients who take the weight loss surgery as an opportunity to make sweeping changes in their life habits. The most successful patients exercise regularly. They also comply with the recommended diet. This means eating three meals per day, eating healthy solid foods , taking 20-30 minutes per meal, not mixing fluids with foods.
Will I just keep losing weight until I waste away to nothing?
Patients may begin to wonder about this early after the surgery when they lose 20-40 pounds in the first month, or maybe when they've lost more than 100 pounds and they're still losing. Two things happen to allow weight to stabilize. First, a patient's ongoing metabolic needs (i.e. calories burned) decrease as the body sheds the load imposed by the excess weight. Second, there is a natural progressive increase in calorie and nutrient intake over the months following gastric bypass. The stomach pouch and the attached small intestine learn to work together better, along with slight expansion in pouch size over a period of months. The bottom line is that, in the absence of a surgical complication, patients are very unlikely to lose down to a point of malnutrition.
What can I do to prevent lots of excess hanging skin? Will exercise help?
Exercise is good in so many other ways that we definitely recommend a regular exercise program, but unfortunately, many patients are left with large flaps of loose skin. In our program we can refer you to plastic surgeons who are available for consultation. These surgeons can help you to learn about ways for dealing with the excess skin resulting from weight loss surgery.
Will I be miserably hungry after bariatric surgery since I'm not eating much? What if I am really hungry?
Most patients say no. In fact, for the first 4-6 weeks patients have almost no appetite. Over the next several months the appetite returns but it tends not to be a ravenous type of hunger due to the types of food you are consuming. You can avoid feeling hungry too soon by making absolutely sure not to drink liquids with foods as liquids tend to wash food out of the pouch.