Pre-op information for all procedures

[GCHCRYSTAL]

Congratulations on your upcoming surgical procedure. You have reached a major milestone in your weight loss surgery journey. This section is for pre-op patients of all WLS procedures. For those who have not yet reached the pre-op stage these will be some very helpful ideas, as these are things we will discuss during that class. For those of you who have already attended the pre-op class this is just a reminder of what we covered. Good luck on your journey! If you have any questions or concerns you can e-mail me at crystal.blackburn@lpnt.net

WLS is just another step in you journey to lose weight and become healthier. As with any lifestyle change one can become very overwhelmed with drastic changes. We want you to start making changes now to decrease your risk of becoming so overwhelmed after your surgical procedure. Depression and regrets (Buyers Remorse) can set in after surgery if you have not already incorporated the changes in your daily routine prior to your surgical procedure.

Dietary Changes:
·Begin a high protein, low carbohydrate, and low fat diet. This will help you lose weight and shrink the liver.
·Wean yourself off carbonated beverages, as this will be a life-long restriction after your surgery. Carbonation, being a gas, can cause stomach gas, which is very painful to your tiny pouch and could over time possibly cause your tiny stomach pouch to stretch.
·Wean yourself off caffeine. Caffeine is strongly discouraged immediately following surgery and for 6 months afterwards. After 6 months you can begin introducing caffeine back in to your diet. Caffeine acts in 2 ways on the body; 1. as a stimulant, can increase your appetite and 2. as a diuretic, can cause you to urinate off more fluids than you take in and cause you to become dehydrated after your surgery during the period you are not able to drink as much.
·No straws for 6 months following your surgery. Using straws to drink, introduces excess air into your new stomach pouch and can cause you to have a false sense of fullness.
·No alcoholic beverages for 6 months following your surgery. Alcoholic beverages are high calorie and empty calories. Consuming alcoholic beverages could cause inadequate weight loss and weight regain. Alcohol can cause you to become dehydrated. After WLS, especially gastric bypass, your body will absorb the alcohol much quicker and you can become intoxicated on a much smaller amount than someone who has not had WLS.
·Your dietary goals for after surgery, once you have made it through all of your diet stages and are eating a normal “Bariatric” portion, are as follows: 70 grams of protein daily (minimum) unless you have renal (kidney) problems that do not allow for that amount of protein, 100 grams or less of carbohydrates daily, 25-33 grams of fat daily, and 64 ounces of fluid daily.

Behavioral Changes:
·All tobacco products, including smokeless and non-smokeless need to be stopped prior to surgery. For Adjustable Gastric Band patients, you must stop all tobacco products 30 days prior to your procedure. For Gastric Bypass, Gastric Sleeve, and ROSE procedure patients you must stop all tobacco products 6 months prior to your procedure and never smoke again. Smoking increases your risk of ulcer formation. Ulcers that form in the small “pouch” are difficult and costly to treat, are very painful, can sometimes require surgical intervention, and can be life-threatening.
·Exercise or increased activity if you are unable to do many exercises, is key to weight loss and long-term weight loss maintenance. Begin a regular exercise program by simply walking each day. You can use a pedometer to keep track of your steps. Increase your distance daily. Increase your activity during your daily routines. While watching television, iron or fold clothes; park farther away from the store when shopping; add a little movement to your body when washing the dishes by stepping in place or tapping your feet. There are many ways you can increase your activity. If you have a gym membership, use it. Get yourself in a habit of daily exercise or added activity. If you do not have time for a 30-40 minute workout, break it up into 10-minute segments throughout your day. Please consult with your primary care provider before starting any exercise program.
·Portion control is very important for weight loss and long-term weight loss maintenance. Starts eating from a salad sized plate, dessert plate, or buy a toddler plate to keep your portions smaller. Retrain your brain. A 6-10 ounce Lean Cuisine meal, for example, is a proper meal size once you are back on all food groups after your surgery.
·Practices cutting your food into small, pinky nail sized bites, chewing only one piece at a time and chewing well.

Medications:
·For all Procedures: 30 days prior to your surgery you must stop all Cotisone/Steroids (including injections, pills, patches, creams, nasal sprays). AGB patients may resume these medications 7 days after your surgery. Gastric Bypass, Gastric Sleeve, and ROSE Procedure patients are restricted for life from taking these types of medications after your surgery. If Gastric Bypass, Gastric Sleeve, and ROSE Procedure patients need to take these medicines after there surgery on a temporary basis, you must wait 12 months after your surgery, contact the surgeons office to inform them of the reason you are taking the medication, and you must take a Proton Pump Inhibitor (PPI) such as Prilosec, Nexium, or Prevacid for 6-8 weeks to reduce your risk of ulcer formation.
·For all Procedures: 30 days prior to your surgery you must stop all forms of birth control medication, with the exception of the Depo-Provera injection which needs to be stopped 90 days before surgery, but you may resume these medications 30 days after your surgery.
·For all Procedures: 30 days prior to your surgery you must stop Estrogen hormone replacement therapy but you may resume it 30 days after your surgery.
·For all Procedures: 30 days prior to your procedure you must stop all garlic and herbal supplements but you may resume them 30 days after your surgery.
·For all Procedures: 7 days prior to your surgery you must stop all aspirin and aspirin containing products. AGB patients may resume these medications 7 days after your surgery. Gastric Bypass, Gastric Sleeve, and ROSE Procedure patients are restricted for life from taking these types of medications after your surgery.
·For all Procedures: 7 days prior to your surgery you must stop all anti-inflammatory medications including but not limited to the following: Ibuprofen, Motrin, Advil, Midol, Aleve, Naprosyn, Naproxen, Celebrex, Daypro, Bextra, Vioxx, Mobic, Diclofenac, etc. AGB patients may resume these medications 7 days after your surgery. Gastric Bypass, Gastric Sleeve, and ROSE Procedure patients are restricted for life from taking these types of medications after your surgery.

General Information:
·Make sure you purchase your required vitamin supplements and start taking them prior to surgery. Look at the Vitamin Supplement forum of the message board.
·Read your Owners’ Manual!!! Your manual will be your bible after WLS.
·Follow your instructions for what you need to do the day before surgery and the day of surgery. If you have any questions let us know.
·Make sure you try your protein samples to see what you like. You will be using protein supplements after surgery during the time you are unable to get your protein through your diet with what you are able to eat.
·Remember: your nutritional goals after surgery (what you are going to be working towards every day) will be as follows:
70 grams of protein daily
Limit fats to 25-33 grams daily
Limit Carbs to <100 grams daily
64 ounces of sugar-free, caffeine-free, non-carbonated fluids

If you have any questions let us know.

Crystal Blackburn, RN
Education & Support Coordinator
The Bariatric Center
Georgetown Community Hospital