Can I ever lose too much weight?
With the possible exception of the rare patient who develops obstruction of the stomach outlet, it is unlikely you will ever lose too much weight. On the other hand, snacking and high calories liquids can put on weight readily.
Will my skin sag?
Because to the large amount of fat between the skin and the true body, the skin will surely sag as fat is removed. Since the weight loss is rapid in the first 6 months, the skin cannot keep up the pace and indeed does sag. During this period, however, elasticity of the skin is improving and the skin is also shrinking. This process will continue over the next one or two years and your appearance will be worse at about 6 months, although it will improve gradually thereafter. Regular and progressive exercise will also help the appearance of the sagged skin. The skin of younger bypass surgery patients recovers more rapidly. Some patients may wish to have excess skin surgically removed at a later time.
Should I eat more and avoid the rapid weight loss in order to prevent sagging?
No, definitely not! The sagging is related to the total amount of weight loss. It only appears worse during the rapid weight loss phase. If anything is done to slow down weight loss in the initial three to nine months, the opportunity for easy weight loss while the pouch is very small, will be lost forever.
What happens to the unused part of the stomach?
It remains in place and its ability to function remains intact. The muscles may loose some of there contractile power, but each cell is still there an capable of functioning in the unlikely event it should be call upon.
Can the stomach be hooked up again?
It is possible, but doing so would result in regaining most of all of the lost weight. We have never been asked to reverse the operation.
What is dumping?
Dumping is the condition that results when sweets very rapidly empty out of the stomach into the jejunum through the small pouch. Sweets have a characteristic called “hyperosmolarity” which means they have a high concentration of particles in solution. One of the functions of a normal stomach is to act as a reservoir where food will be held and emptied into the small bowel bit by bit, rather than “dumped” into the digestive/absorptive part of the intestine. If the latter were to occur, the jejunum would react by sending off chemical signals to stop the intake of such materials on such a rapid basis. These chemical signals cause nausea, dizziness, and faintness. The chemical signals are relatively harmless but they should not be repeated in orders to avoid these unpleasant symptoms. This might be a bad thing if one continued to crave sweets, but most sweet lovers will come to loathe sweets after this symptom occurs a few times. The avoidance of sweets under the circumstances is called an “aversion reaction.” The avoidance of sweets by the patient who has had a gastric bypass procedure probably accounts for a significant part of the weight loss results.
Why do some suffer more gas or diarrhea than others?
May I have my pouch made smaller if it grows too much, and what is involved?
It can be made smaller by another operation, but it is more difficult and dangerous than the first because of the degree of scaring around the stomach due to the previous surgery.
How do I know how large the pouch has grown to?
The size of the pouch after surgery is the most difficult parameter to measure. An upper GI series, endoscopy (looking at the stomach directly through a tube), and other test have not been of much help.
Is there a chance to regain weight?
Some patients may come to feel frustrated and discouraged after weight levels off but is yet too high, or when slow weight regain occurs. This cannot go uncorrected. While responsibility to continue making progress and to avoid regression remains with the patient, help will be available. It is important to constantly realize that the pouch is there only as a tool and must be used properly. If this leveling off or regression happens, support may be necessary and it is important to come back to see us so we may evaluate your case. We will then go back into your history and review the thing you have learned in your first evaluation and from this booklet. Re-evaluation does not mean either the operation or you have failed. We are aware it often requires considerable time and effort to change the habits of a lifetime. We understand your predicament. We want to be viewed not as a critic, but as a coach and friend.
What is your advice to me?
The Hays Medical Center Bariatric Services group reaffirms to you its commitment to provide the very finest surgical care for the disease of clinically severe obesity. It is our privilege and pleasure to serve you in that commitment. If we can be of further assistance or provide you with more information, please call our bariatric nurse coordinator at (785) 623-5945.
1) Insurance Process
It is important to check with your insurance company prior to starting this process. Call the toll-free number listed on your insurance card for either benefits or customer service and ask the following questions.
- Ask if the procedure code is a covered benefit.Roux-en-Y Surgery Code 43644
Lap BAND Surgery Code 43770
Sleeve Gastrectomy Surgery Code 43659Be sure to clarify that you re asking about the procedures on the basis of medical necessity.
- Do you have any specific criteria that must be met to have weight loss surgery?
- Are my surgeons and Hays Medical Center providers under my plan?
- Are nutrition, physical therapy and psychological evaluations covered?
Do Not start the pre-cert or pre-authorization process or send anything to your insurance company regarding your request for surgery. The Bariatric Nurse Coordinator will handle this process after we receive all the needed information.
Not all insurance plans cover weight loss surgery. If the insurance company state that it is covered based upon medical necessity, the surgeon will write a letter to your insurance company describing why you specifically need the surgery done. If the insurance company instructs you that you have contract exclusion or that it is not a covered benefit then you will need to be able financially to cover the cost on your own. If self-payment is elected, payment is required in advance of your surgery date for this elective procedure.
2) Informational Seminar
Attend on of the Information Seminars offered by the Bariatric Providers.
3) Psychological Evaluation
A pre-surgical psychological evaluation includes determination of the patient’s ability to understand explanations and instructions. It includes verification of adequate understanding of the procedure, risks of surgery, as well as important compliance and outcome factors. The adequacy and status of social/emotional support system is assessed as well. Psychosocial history and psychological testing are used to confirm the absence of psychological problems which could undermine understanding, compliance, and successful adaptation to bariatric surgery.
When people decide that they are ready for weight loss surgery, there is often a desire to complete the surgery as quickly as possible. In order to secure psychological and surgical approval, they may be tempted to downplay past psychiatric history or complicating personal situations and factors. People should understand that the goal of our team at Hays Medical Center Bariatric Services is to get everyone to surgery, which can ultimately benefit. A weight loss surgery should work to the person’s advantage both in the long-term and short-term. However, people with important psychological contra-indications will not be immediately recommended for surgery until these concerns can be satisfactorily resolved or addressed. More commonly, patients with important psychological risks would be recommended for surgery contingent on concurrent treatment and monitoring of specific problems.
Therefore, the goal of treatment prior to surgery is to “prepare” people for the upcoming stressors and changes. It is crucial to your ultimate outcome to disclose your current psychological and social state, and to work with the mental health care provider performing your pre-surgical evaluation on a plan to prepare you for the stressors and successes which lie ahead.
To make an appointment for your psycological evaluation with Hays Psychological Associates call 1-785-623-6270. Also we recommend you check with your insurance company for benefit coverage regarding psychological evaluations.
Your Control = Fluid Intake + Protein Intake + Exercise
2. Eat only good, solid food – protein first.
3. Eat slowly, sense fullness, and then stop.
4. No eating between meals – drink a protein shake instead.
5. Drink NO liquids with your meals.
6. Exercise at least 30 minutes each day.
7. Consume your protein!
8. Drink plenty of water – MINIMUM of 64 ounces a day.
9. Take your vitamin/mineral supplements religiously.
10. Get the support that you need from friends/family/groups. Develop your own personal relapse prevention plan.
4) Dietitian Consult
Dietitian consultations are necessary prior to bariatric surgery. Dietitian consults are available at Hays Medical Center. A consultation with the dietitian requires a physician’s order. Your primary care physician can fax the physician’s order to the dietitian regarding a pre-bariatric surgery consultation. The number for the dietitians at Hays Medical Center is fax 785.623.5529. After receiving the physician’s order, one of the dietitians will call you to schedule an appointment time.
5) Postoperative Exercise
On your first postoperative day, you will be getting out of bed and walking in your room and in the hall with assistance. Remember to point and flex your feet every 15-30 minutes to prevent blood clots from forming in your legs. Use your incentive spirometer to deep breathe and cough every hour to expand your lungs and prevent pneumonia. Smoking or being around others who smoke is a health risk that you will want to avoid. On the second postoperative day you will be walking in the hall three times a day. The third postoperative day you will be walking in the halls at least four times a day.
During Week One at home you can walk around your home according to the Beginning “Get Moving” Program and lift up to 1- 2 pounds. During Week Two, you can walk on a treadmill or use a stationary bike, slowly progressing your exercise time by adding 1-2 minutes each day. You can lift up to 5 pounds. At One Month, you will have a follow-up visit to you doctor for a postoperative checkup. There are No Activity Restrictions for your activity or lifting unless your doctor advises you otherwise.
Phase IV – A Lifetime of Movement
Find out more HERE.
6) Are there Support Groups?
- Hays Bariatric Services support group meetings are open to candidates going through the surgery process at Hays Medical Center, people who have had bariatric surgery at Hays Medical Center and their support person.
- Our support group meetings are a safe place to share feelings, and to obtain and provide support.
- Hays Bariatric Services support group meetings are informational, reassuring, and encouraging.
- We ask that any conversation or information that is shared by people at support group meetings is kept confidential.
- Silence is acceptable. No one needs to say anything he/she does not wish to say.
- If anyone has a sensitive issue, you may speak to the group leader in private or call the office.
- Participants will be notified by phone, mail or e-mail monthly about the upcoming dates and locations of the support group meetings.