The boring but good to know stuff

Section 2


Frequently Asked Questions
I like that there is an FAQ section in the manual.  There are 46 questions and answers about the whole process.  I'm not going to list all those out, but it is a very extensive list.  Ones that stood out to me are:

• Why do you get an EGD (that scope thingy I had done last month)?  Many morbidly obese patients have reflux and ulcer disease which is not diagnosed and may need treatment prior to surgery.  Furthermore, once the stomach is divided, evaluating the stomach will be difficult and if abnormalities are found at the time of the EGD, treatment can take place before the gastric pouch is divided.  This does not prevent things from happening in the future.  Note that stomach cancer is not associated with gastric bypass.
• How is the stomach divided? A stapler is used to divide the stomach. The two parts of the stomach will be separated completely.  (Why does the scene from the movie Office Space come to my mind?  You know, the one where Milton is explaining why he kept his Swingline stapler after the company switched to the Boston staplers?)
• How much intestine is bypassed?  The "roux" (or bypass) limb will vary from 75-150 cm, but most likely it will be closer to the 150 cm length.
• What size is the stomach pouch?  Approximately 30ml or 1 ounce; the size of an egg.  (That's pretty small - see diagram below.)
• Do you cut the acid producing nerves to the stomach?  No.  Some surgeons prefer to cut these vagus nerves to minimize ulcers but this is not the standard of care.  You will still have acid in your digestive tract to break down the food.
• When can I drink water and other liquids?  After your UGI (upper GI x-ray) on postoperative day 1 is cleared you can drink.  Your bariatric diet will begin at this time.  Your nurse will let you know when to start drinking and help you keep records of how much was consumed.
• How do people die from gastric bypass surgery?  Most patients die from either leaks resulting in peritonitis or from clots in their legs traveling to the lungs (pulmonary embolism).  The risks will be discussed with you in detail prior to your surgery.  (This is actually a concern that my youngest son had about me having surgery.  Keep him in your prayers as he's not really sure about the whole thing.)
• Why do you not remove the other part of the stomach that is divided?  It continues to secrete important juices for digestion and removal of this organ has been associated with more postoperative complications.
• What about the extra skin after I have lost all that weight?  After 18-24 months, most patients will plateau with respect to their weight loss/gain and referral to a plastic surgeon will be an option for excision of extra skin.
• What are some common side effects after surgery?  Nausea, vomiting, hernia at incision site, infection at incision site, general fatigue and constipation are often seen after surgery, but all resolve or can be fixed without much trouble.
• Is rapid weight loss dangerous?  Yes.  Usually this danger is because the patients don't consume the essential nutrients during this time period.  The bariatric center will be working with you on a regular basis to prevent this from happening.  Essentially this danger is eliminated if you follow the recommendations of the nutritionist/dietitians. 
• Can I drink coffee and soft drinks after surgery?  Caffeinated drinks dehydrate your body and should not replace other fluid supplement such as juice or water.  Carbonated beverages can cause painful gas and potentially unwanted pressure on the staple lines.  Leaks could happen from this.  Soft drinks that are "flat" are more acceptable once you are eating your lifetime diet. (Forget that!  Flat soft drinks are icky!)
• What is dumping syndrome?  When you eat pure or refined sugars (high caloric foods), these immediately enter the small bowel causing fluid to rush in to the intestine as part of digestion.  This action is associated with flushing, sweating, rapid heart beats, abdominal pain, and diarrhea. The degree of dumping depends on the amount and type of food.  It usually subsides in 30 minutes.  Try to learn what food causes these symptoms such that they are avoided in the future.

Discharge Instructions

The postoperative phase of gastric bypass can be very demanding of your mental and physical endurance.  What details do I need to remember after surgery?

Surgery performed / wound care - standard post-op wound care instructions.  Keep it dry; don't take the steri-strips off until advised by the doctor; notify the doctor if there is bleeding from the suture line, the skin starts to separate, pus or cloudy fluid is seeping from the incision, the incision or abdomen become increasingly painful and medication is not controlling the discomfort, fever >101, inability to urinate or pass stool/gas.

Activity - laparoscopic surgery: May resume any and all activities when comfortable; may return to work in 1-3 weeks if no problems arise; WALK as much as tolerated; expect your endurance to be low initially, but will improve; no driving until cleared by surgeon.

Medication - do not take aspirin, or aspirin containing medicine (ugh! Excedrin  is usually the only thing that works for my headaches!); Immodium AD to help with post-op diarrhea as needed; Gas-X can be beneficial; Fiber supplements with Metamucil or Fibercon are recommended once you are are on the pureed diet; some pills will be rather large and difficult to digest.  Crush if possible. Some medications dosages may even need to be altered to accommodate for the altered digestive tract.  You will need to take an antacid medication (chewable Pepcid or stronger) for approximately 6 months after surgery to lesson the chance of marginal ulcer formation.

Diet - At time of discharge, you have been advanced to Phase III or full liquids.  You'll maintain this regimen until your first postoperative visit by the dietitian and then should advance to a pureed diet. (More on the phases in a different post.)  Remember to drink 48-64 oz of fluid per day - sipping but not with a straw.  Straws can lead to swallowing of excess air.

General Concerns - any of these should prompt you to call your doctor: sudden shortness of breath or tightness in our chest not relieved by resting; uncontrolled nausea with vomiting; increased abdominal pain or new chest pain; persistent hiccups; leg pain or swelling.

Again, this is just a little of the information in this section.  For me it's the "boring" but good to know" stuff.  It also helps me to feel even more informed about the procedure.  It's good not to enter into a major event being ignorant of the details.  

My next appointment is tomorrow and I feel like I'm right on target where they want me to be.  If so, that means MD should give the thumbs-up to the insurance company and we'll work on getting a concrete date set!  It's hard to believe how quickly this process is going.  I first stepped foot into bariatric center in September 2011.  The time has flown by!  I'm anxious to see where I am in another 6 months!

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"I praise you [God] because I am fearfully and wonderfully made; your works are wonderful, I know that full well." ~Psalm 139:14