Frequently Asked Questions

Below are some common questions related to metabolic and bariatric surgery. Please contact us for any question for which you have not found an answer or attend a seminar to learn more.

Pre-Operative Phase

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Is there anything I can do to prepare for surgery?

Yes.

STOP SMOKING: Smoking has a significant influence on your surgical outcome, including the chance of dying around the time of surgery. Everyone knows that smoking causes lung problems, patients who smoke have a 5-10 fold increase in infections, impaired wound healing, heart attack, deep vein thrombosis (DVT), and pulmonary embolism (PE).
Lose weight before surgery: The heart and lungs, as well as other organs in the body, are negatively affected by obesity. Losing just 5 to 10 percent of your excess weight will decrease stress on your body. WE WILL HELP YOU WITH THIS WEIGHT LOSS!
Exercise: Get your heart and lungs in the best possible shape by doing whatever physical activity you can tolerate.
Prepare Mentally: Consider your surgical journey as the beginning of a whole new lifestyle. If you approach surgery with education and determination to make the best of the opportunity, the chances of success are very high. Be ready for a change.
Attend a support group - We offer monthly support groups and encourage patients to attend regularly. Much can be learned from other patients both in the pre-operative and post-operative phases.

What can I do before the appointment to speed up the process of getting ready for surgery?

Contact your health insurance company to learn about coverage of bariatric surgery.
Establish a relationship with a primary care physician if you don't already have one. Work with your physician to get "caught up" on your health maintenance and routine testing.
Discuss the symptoms of obstructive sleep apnea with your primary care doctor and participate in testing or treatments recommended.
Bring any pertinent medical data with you to your appointment to see your bariatric 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 including doses and frequency.
STOP SMOKING. Discuss a smoking cessation plan with your primary care physician.

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 any problems because he/she is most familiar with your medical history and previous operation. Your second option is to call us to make an appointment. You will need to provide an operative report from your first operation as well as any recent imaging or testing you have had.

What about insurance coverage?

Insurance coverage for treatment of morbid obesity is constantly changing. We have developed a dedicated staff who will be happy to assist you during the insurance approval process.

Surgical and Recovery Phase

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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 (a 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. If you have a history of blood clots, we will prescribe additional treatment for the immediate post-operative period to decrease the risk of re-occurrence.

What happens to the lower part of the stomach that is bypassed?

This is left 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.

How do I eat after bariatric surgery?

During bariatric surgery, the size of the stomach is drastically reduced. The modifications made to your gastrointestinal tract will require permanent changes in your eating habits. You may hear of other patients being given different guidelines following their weight loss surgery. It is important to remember that every patient does not undergo the same surgery and the dietary guidelines will be different for each type of procedure. It is important is that you strictly adhere to your surgeon's recommended guidelines.

The following are some of the generally accepted dietary guidelines a weight loss surgery patient may encounter:

When you start eating solid food it is essential that you chew thoroughly. You will not be able to eat steaks or other chunks of meat if they are not ground or chewed thoroughly.
Don't drink fluids while eating. They will make you feel full before you have consumed enough food.
Omit desserts and other items with sugar listed as one of the first three ingredients.
Omit carbonated drinks, high-calorie nutritional supplements, milkshakes, high-fat foods, and foods with high fiber content.
Avoid alcohol.
Limit snacking between meals.

What important digestive functions do people lose when the lower stomach is bypassed?

The bypassed stomach and small intestine play important roles in the absorption of iron, calcium, and vitamin B12, thus we require patients to take these supplements and we follow blood levels of these and other nutrients for life.

What is dumping syndrome?

A 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 effects a person feels after consuming concentrated sugar after a gastric bypass (such as ice cream, chocolate candy, or a soda) is a reaction called dumping syndrome which affects the entire body.

During an episode of dumping, you may feel sweaty or clammy, have palpitations (i.e. heart racing), 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 is not pleasant. Avoiding refined sugars and concentrated sugars will decrease your risk of experiencing dumping syndrome.

Patients with gastric sleeves do not usually experience dumping syndrome.

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 staples used on the stomach and the intestines are very tiny in comparison to the staples you will have in your skin, or even staples used in an office. Each staple is made of tiny pieces of stainless steel or titanium. Because these metals are totally inert in the body, people are not sensitive 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 nor set off airport metal detectors.

Can I get pregnant after metabolic and bariatric surgery?

Yes, but we strongly recommend waiting at least two years after the surgery before becoming pregnant. Please consider reliable birth control for 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

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Will I be miserably hungry after bariatric surgery since I'm not eating much? What if I am really hungry?

No. Your appetite will decrease due to decreased levels of ghrelin, also known as the hunger hormone.

Will I have to change my medications?

Many medications such as those used to control blood pressure, diabetes, etc., can be stopped at some point after surgery. Please ask your provider during your follow up appointments.

What can I do to prevent lots of excess hanging skin? Will exercise help?

Exercise is recommended. Unfortunately, some patients retain large flaps of loose skin after rapid weight loss and exercise will not be as effective in decreasing that. In our program, we can refer you for a consultation with a plastic surgeon. This type of surgeon can help you explore ways to manage excess skin as a result of weight loss.

When do I follow up with Upstate's bariatric clinic?

Appointments following bariatric surgery are critical. When you are losing weight, you will be asked to follow up frequently. We ask patients to come back to the clinic at 2 weeks, 4 weeks, 3/6/9/12 months and then yearly for life. At your annual visits, we will monitor your success and order blood work to check for anemia (low red blood cell count), as well as low Vitamin B12, folate and iron levels.

Learn more here.

Where do I find additional support?

Our program has support groups in place to assist with your short and long-term questions and needs. The use of support groups provides weight loss surgery patients an excellent opportunity to discuss their various personal and professional issues. Many also find support for emotional issues that years of obesity can cause. Most bariatric surgeons will tell you that ongoing post-surgical support helps produce the greatest level of success for their patients.