Bariatric Surgery Patient Binder - Baptist-health

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Bariatric SurgeryPatient BinderBariatric Surgery Patient BinderLITTLE ROCKEric Paul, M.D. Tripurari Mishra, M.D. Kelly Bassett, A.P.R.N.

Bariatric SurgeryPatient BinderTable of ContentsSurgical Excellence Comes With Experience.3Welcome.4What will YOU gain by losing?.5Baptist Health Map and Helpful Phone Numbers.6Meet Our Team. 7Write your questions here.8Introduction to Obesity.9Body Mass Index (BMI). 10Weight Loss Surgery. 11Excess Weight Loss (EWL). 12Roux-en -Y Gastric Bypass. 13Sleeve Gastrectomy. 14Bariatric Revision Surgery. 15Surgery Risks and Complications. 16Weight Loss Surgery Considerations.17What I Wish I Knew Before Weight Loss Surgery. 18Your Lifelong Commitment. 19Pause and Reflect. 19Preparing for Your Surgery. 20Social Support. 21Tracking Success. 22Tracker. 23General Nutrition Information. 24Nutrition - Protein. 25Nutrition - Carbohydrates. 26Nutrition - Fats.27Serving Sizes of Different Foods. 28Healthy Eating Guidelines. 29Common Names for Sugar. 30Reading Nutrition Labels. 31Reading Ingredient Labels. 32Portion Control Using Common Items.33Template to Create a Balanced Meal Plan.34Bariatric Pre-Op Shopping List - Recommended Items. 35Vitamins. 36Protein Shakes and Powders. 38Bariatric Pre-Op Phase (Liver Shrinking Phase). 40Pre-Op Phase (Liver Shrinking) Meal Examples. 411

Bariatric SurgeryPatient BinderPhase 1 Clear Liquids / Protein Drinks (Post-Op Days 1-3). 42Finding it hard to drink enough water?.43Phase 2 Full Liquids / Protein Drinks (Post-Op Days 3-14).44Phase 2 Sample Meal Plan. 45Phase 3 Soft Foods (Post-Op Weeks 3-4). 46Phase 3 Sample Meal Plan. 48Phase 4 Soft /Chopped Foods (Post-Op Weeks 5-8). 49Phase 4 Sample Meal Plan. 51Lifetime Eating Phase (Post-Op Week 9 ). 52Lifetime Phase Sample Meal. 53Recipes. 55-66Going Out to Eat.67Physical Activity. 69Post-Op Physical Activity.70Milk Jug Workout.71Examples of Workout.742 Weeks Before Surgery: To Do.752 Days Before Surgery: To Do.76Day of Surgery: To Do.77Day of Surgery: Process.78Hospital Stay.78Expectations After Surgery?.79Post-Op Medications.79When to Call?. 80Nausea, Vomiting, or Food Getting Stuck. 81Constipation. 82Dumping Syndrome. 83Changes After Surgery. 84Mindfulness for Eating. 85Mindfulness for Sleep. 86Journaling and Self-Reflection.87Daily Food Record. 89Post-Op Map - Year 1. 90Post-Op Map - Year 2. 91Lifelong Follow-up Map. 92Risk Factors for Weight Regain After Bariatric Surgery. 93References. 942

Baptist Health Bariatric Center-Little Rock is designated as aa Bariatric Center of Excellence anda Metabolic and Bariatric Surgery Institute of Quality.This designation identifies our surgical team and program as providing quality,effective care for our patients before and after surgery.31

Bariatric SurgeryPatient BinderWELCOMEThank you for choosing the Baptist Health Bariatric Center and putting your confidence inour team. We will guide you through the process, celebrate all of your successes, and supportyou through struggles. We will prepare you with what to expect and how to navigate thelifestyle changes.The Baptist Health Bariatric Team knows that bariatric surgery requires education and support tobe successful. This book will be your go-to guide along the way. You will want to take it with youto all of your appointments, read through it carefully, and write down any thoughts, questions,and goals you have. This book will be a valuable resource to help you become better preparedbefore, during, and after surgery. Our goal is to make your journey a success!The Baptist Health Bariatric Center is committed to helping patients live a healthier, happierlifestyle through successful weight loss and long-term weight management. We are here to helpyou every step of the way!The Baptist Health Bariatric Center Staff4

Bariatric SurgeryPatient BinderWhat willYOU gain by losing?5

Bariatric SurgeryPatient BinderBaptist Health Map and Helpful Phone NumbersBaptist Health Medical Center-Little RockBaptist Health Surgical Clinicof Central Arkansas9601 Baptist Health DriveLittle Rock, AR 72205Hickingbotham Outpatient CenterBaptist Health Bariatric Center9500 Kanis Road, Suite 501Little Rock, AR 72205Hickingbotham Outpatient Center(501) 227-90809500 Kanis Road, Suite 503Little Rock, AR 72205For questions before surgery,call (501)-202-4477.(501) 202-4477For questions or concerns after surgery,call (501)-227-9080.6

Bariatric SurgeryPatient BinderMeet Our TeamEric Paul, MD, FACSstudied at Baylor University and graduated from the Universityof Arkansas at Fayetteville. He then attended medical school atthe University of Arkansas for Medical Sciences. He completed hisGeneral Surgery residency at the University of Oklahoma Collegeof Medicine in Tulsa, Oklahoma and after concluding a Fellowship inAdvanced Laparoscopic Surgery and Bariatric Surgery at EmoryUniversity. He joined our team in 2010.Tripurari Mishra, MDattended medical school at Saint Louis University School ofMedicine. He then completed his General Surgery residency atthe University of Illinois Chicago Metropolitan group Hospitals.He then went on to complete a Fellowship in Minimally InvasiveSurgery/Bariatric Surgery at Gundersen Lutheran Health System.Dr. Mishra is American College of Surgeons Board Certified.Kelly Bassett APRNattended school at Baptist Health School of Nursing where sheobtained her Associate’s Degree. She then received her Bachelor’sDegree at Arkansas Tech University. She then went on tocomplete her Family Nurse Practitioner degree at ChamberlainUniversity. Kelly is American Academy of Nurse PractitionersCertified.Mitchell Kirby, RDN, LDstudied at Harding University for his Bachelor’s Degree. Hethen completed his Dietetic Internship through UAMS/CAVHS,and is currently completing his Master’s Degree of ClinicalNutrition through UAMS. Mitchell is a Registered DietitianNutritionist and Licensed Dietitian.7

Bariatric SurgeryPatient BinderWrite your questions here:8

Bariatric SurgeryPatient BinderIntroductionto ObesityPeople with severe obesity are at an increasedrisk for more serious disease such as:42.4% of adult Americansover the age of 20 areobese. (CDC)Obesity is when a person carries excess weightor body fat. Obesity can cause damage to yourbody and lead to serious health risks. Type 2 diabetes High blood pressure (hypertension) Coronary heart disease Cancer Stroke Sleep apnea and breathing problems Osteoarthritis (a breakdown of cartilageand bone within a joint)In some cases, these conditions can lead todisability or early death.How obesity affects your body:9

Bariatric SurgeryPatient BinderBody Mass Index(BMI)We screen for obesity by calculating bodymass index (BMI). BMI measures an individual’sweight in relation to their height. Use the tablebelow to check your BMI. Both men andwomen use the same chart to measure obesityand the same classifications of obesity applyto both sexes.My Height:My Weight:My 3334EXTREME OBESITY41424344454647484’10”9196 100 105 110 110 119 124 129 134 138 143 146 153 158 162 167 172 1774’11”94995’97102 107 112 118 118 128 133 138 143 148 153 158 163 169 173 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 2553537383949502029364019BMIWEIGHT(IN POUNDS)HEIGHT181 186 191 196 201 205 210 215 220 224 229 234 234104 109 114 114 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247116 122 122 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 2645’1”100 106 1115’2”104 109 115 120 128 128 136 142 147 153 158 164 169 174 180 185 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 2735’3”107 113 118 124 130 130 141 146 152 158 163 169 175 180 186 192 197 203 208 214 220 225 231 237 242 248 254 259 265 270 278 2825’4”110 116 122 128 134 134 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 2915’5”114 120 126 132 138 138 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 3005’6”118 124 130 136 142 142 155 161 167 173 179 186 192 198 204 210 218 223 229 235 241 247 253 260 266 272 278 284 291 297 303 3095’7”121 127 134 140 146 146 159 166 172 178 185 191 198 204 211217 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319177 184 190 197 203 210 216 223 230 236 243 249 256 262 269 276 282 289 295 302 308 315 322 3285’8”125 131 138 144 151 151 164 1715’9”128 135 142 149 155 155 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 3385’10”132 139 146 153 160 160 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 3485’11”136 143 150 157 165 165 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286 293 301 308 315 322 329 338 343 351 3586’140 147 154 162 169 169 184 191 199 206 213 221 228 235 243 250 258 265 272 279 287 294 302 309 316 324 331 338 346 353 361 3686’1”144 151 159 166 174 174 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378179 179 194 202 210 218 225 233 241 249 258 264 272 280 287 295 303 311 319 326 334 342 350 358 365 373 381 3896’2”148 155 163 1716’3”152 160 168 176 184 184 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 3996’4”156 164 172 180 189 189 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410REDUCED RISKINCREASED RISK10

Bariatric SurgeryPatient BinderWeight Loss SurgeryBariatric surgery, or weight loss surgery, is atool to help people lose weight. Whenaccompanied by permanent lifestyle changes,it can help individuals achieve lastinghealth benefits.Bariatric Surgery Benefits: Long-term remission fromType 2 Diabetes Reduce weight-related medicalproblems such as high bloodpressure, high cholesterol, andsleep apnea Improve infertility Improve mobility and decreasejoint pain Lower risk of heart disease,cancer, and strokeIn this book, we will provide more informationabout each of these procedures. During theinitial consultation with the physician, you andyour surgeon will discuss the procedures anddecide on a plan that meets your needs.Baptist Health Bariatric Center offers the latest and safest weight loss surgery options: Sleeve Gastrectomy Roux-en-Y Gastric Bypass Revisional surgeryDo not compare yourself to others who have had the surgery,everyone’s weight loss journey is different.11

Bariatric SurgeryPatient BinderExcess Weight Loss (EWL)As you start losing weight after surgery, we calculate the percent (%) of the excess weight you havelost. The percentage of the excess weight you lose is your EWL.My Pre-op Weight:lbsWeight for a BMI of 25 at my Height:(see the table page 14)lbsSubtract the two numbers.This is your current excess weight:lbsEWL (Excess Weight Loss) (amount of weight you lose / excess weight) x 100%EWL of 50%, maintained over five years, is considered a successful surgery.Example 1:Excess Weight 150 lbsWeight loss after surgery 75 lbsEWL (75/150) x 100% 50%Example 2:Excess Weight 250 lbsWeight loss after surgery 200 lbsEWL (200/250) x 100% 80%With these calculations, you will be able to better trackyour progress and continue to work towards your goals.12

Bariatric SurgeryPatient BinderRoux-en-Y Gastric Bypass (RNY)NormalRoux-en-Y m(bypassed)JejunumJejunumFacts about a “gastric bypass”Disadvantages: Oldest and most studied weight loss surgery Promotes weight loss in different waysSlightly higher complication rates than theSleeve procedure - complications includethe possibility of leaks, bleeding, bloodclots, infection, and blockages Possible long-term micronutrientdeficiencies - must take vitamins for therest of your life Surgery is not easily reversible (very rarelydone)Restricts the amount of food that thestomach can hold.Limits the calories and nutrients absorbedfrom the food you eat.Changing your gut hormones, making youfeel full after eating only a small amountof food.Advantages:Hospital Stay: 1-2 nights Average 60-80% of excess weight loss(individual results vary)Return to work: 1-3 weeks Effective for GERD Obesity-related health conditions maybegin to improve before you lose weight13

Bariatric SurgeryPatient BinderSleeve GastrectomyFacts about a “sleeve”Disadvantages: Most popular weight loss surgery 10-20% of patients regain their weight Promotes weight loss by restricting theamount of food you can eat. Some patients experience relief of GERDwhile other may develop GERD after thesleeveThe minimally invasive procedure removesa portion of the stomach, making thestomach roughly the size and shapeof a banana.Hospital Stay: 1-2 nightsReturn to work: 1-3 weeksAdvantages: Average 60-70% of excess weight loss(individual results vary) Short recovery time, no anastomosis Few long-term complications14

Bariatric SurgeryPatient BinderBariatric Revision SurgeryFacts about Revisional Surgery:Reasons for Revisional Surgery: The pouch may stretch and becomelarger The outlet of the pouch may increase indiameter A gastrogastric fistula may form betweenthe gastric pouch and the bypassed stomach The intestine may increase its absorptiveabilities beyond what is expected Patients who have experiencedcomplications or negative effects as aresult of weight-loss surgery may requireadditional procedures to correct theoriginal operation.Promotes weight loss by restrictingthe amount of food you can eat. Theminimally invasive procedure removesa portion of the stomach, making thestomach roughly the size and shapeof a banana.Other possible reasons:15 Adjustable gastric band (Lap-band) failure Pouch enlargement Sleeve failure Gastrogastric fistula Weight regain

Bariatric SurgeryPatient BinderSurgery Risks and ComplicationsSleeve Complications:We take all necessary precautions to preventcomplications. However, all surgeries haverisks. It is important to understand these riskswhen making a decision about surgery. Risks for all Surgeries: Bleeding and Injury to Vital OrgansHeart AttackStrokeBlood Clots and Pulmonary EmbolismAtelectasis and PneumoniaNerve injuries to arms and legsDeath Bypass Complications: Risks for all Bariatric Surgeries: Converting from a Laparoscopic to anOpen Procedure Leaks can occur due to staple lines ordue to poor healing Infection, Abscess, and Fistula Hernias can develop after any type ofabdominal surgery Obstructions can occur due to scar tissue Gallstones can occur due to rapidweight loss Change in body image, depression,divorce, suicide, risk of substanceabuse disorders Weight regain can occur if the appropriatedietary guidelines are not followed. Food Intolerances: red meat, milk, highfiber foods, etc. Improved infertility, notably in females withpolycystic ovary syndrome (PCOS) There are additional risks that are specificto the different types of surgery.DehydrationReflux, GERDDumping Syndrome, see page 92Malnutrition, Vitamin and NutritionalDeficienciesAnemiaPouch DilationObstruction of Stomach Outlet DehydrationDumping Syndrome, see page 87Short Bowel SyndromeMalnutrition, Vitamin and NutritionalDeficienciesHypoglycemia (low blood sugar)AnemiaOsteoporosisBile Reflux GastritisObstruction of Stomach OutletKidney StonesSymptomatic GallstonesAlcohol Addiction TransferWarning Signs of Complications:16 Pulse greater than 120 beatsper minute Fever greater than 101 degrees Shortness of breath Excessive abdominal pain Vomiting

Bariatric SurgeryPatient BinderWeight Loss Surgery ConsiderationsYour Risk FactorsThe extensive evaluation you undergobefore surgery takes these and other factorsinto consideration.Each weight loss procedure is associated witha different set of risks, which may vary basedon your specific medical condition. During aconsultation with your surgeon, they will reviewyour medical history, discuss potential riskfactors, and answer all of your questions.Your Weight Loss GoalsThe percent of weight you are expected tolose and the rate at which you lose weightdiffers for each surgery.After a discussion with your surgeon of thebenefits, risks, as well as your goals, the two ofyou will decide on the most suitable procedurefor you.Your Medical HistoryYour history with medical problems such asacid reflux and diabetes – and how long you’vehad them – can make one surgery better foryou than another.17

Bariatric SurgeryPatient BinderWhat I Wish I KnewBefore Weight Loss Surgery1.I did not know that I would feel as goodas I do now. Many patients agree thatthe surgery is the best thing they didfor themselves.4. How long it takes for my brain to see meas my current status. I still “feel” like anoverweight person. Many patients say theystill see themselves at their pre-surgery size.2. The importance of holding myselfaccountable with eating, exercise,daily vitamins, etc. You are ultimatelyresponsible for what you put into yourbody. The surgery is just a tool for youto use, not a magic “Fix All.”5. Emotional eating and cravings don’t goaway. You will still have to manageemotional eating and cravings. Weight losssurgery does not affect this. It only changeshow much food you can eat at one sitting.6. How difficult maintaining weight loss canbe. As cravings come back and you are ableto tolerate more foods, the maintenancephase can be more challenging. It isimportant to stay connected to the supportgroup and with follow-up appointments.3. How long a weight loss stall lasts.Everyone will have weight loss stalls.Use this as a time to evaluate your eatinghabits, activity level, and other habits.A stall can be frustrating but it can also beused as a learning opportunity. Don’t leta stall result in starting bad habits again.7. Finding other things that give you joy is agood feeling. Life without food as the focuspoint can be exhilarating!18

Bariatric SurgeryPatient BinderYour Lifelong Commitment1. Make good food choices2. Physical activity3. Take vitamins daily4. Attend a Bariatricsupport group5. Follow up annually6. Avoid smoking7. Avoid alcoholPause and ReflectI feel most interested in the surgery.My Goals:19

Bariatric SurgeryPatient BinderPreparing for Your SurgeryDiabetes Medication - If you take medicationpressure machine, it is likely a family memberhas one. They are fairly inexpensive at discountstores or online.for your blood sugar, your medicationrequirements may go down in the week beforesurgery. Check your blood glucose so youknow where your blood sugar is daily or moreif they seem to be changing frequently unlessyou have a continuous glucose monitoringdevice. Develop a plan with your prescribingphysician for decreasing your medication if youtake insulin. Be sure you know how to rescueyourself from hypoglycemia if needed.Smoking - If you smoke or vape, stop.Stop smoking cigarettes and using all nicotineproducts (patches, gum) at least 6 weeksbefore surgery. Tobacco should also beavoided after surgery due to increased riskof poor wound healing.Birth Control - Losing weight after surgerycan increase a woman’s fertility, making youmore likely to get pregnant. However, rapidweight loss can be unsafe for a developingfetus. For this reason, pregnancy is notrecommended for 18-24 months after surgery.Hypertension Medication - If you takemedication for high blood pressure, you needto be mindful that this requirement may alsogo down as you consume only the clear liquidsbefore surgery. If you do not have a bloodAll women of childbearing age are recommended to use reliable birth control methods before andafter surgery. Talk with your healthcare provider to discuss your options:BEFORE SURGERY All methodspermittedAFTER BYPASS Oral birth control pills do notabsorb properly after bypasssurgeryOnly non-oral birth controlmethods permitted: IUD,condom, Nexplanon (implant),NuvaRing, Depo-Provera(injection)20AFTER SLEEVE All methodspermitted

Bariatric SurgeryPatient BinderSocial SupportSupport GroupFamily and FriendsYour success after bariatric surgery is highlyimportant to us. We highly encourage patientsto join our Baptist Health Bariatric SupportGroup page on Facebook. Support Groupsallow for interaction with others who havebeen through the same procedure. You will beable to share what life is after surgery as wellas learn what to expect from the procedure.Engaging families in behavior change mayhelp you and your family to become healthier.Involving loved ones in your plans would helpthem to understand your journey and give anopportunity to grow together. Ask themto take over some household chores whileyou have time for self-care. Also, ask themto keep trigger f

Bariatric Surgery Patient Binder Weight Loss Surgery Bariatric surgery, or weight loss surgery, is a tool to help people lose weight. When accompanied by permanent lifestyle changes, it can help individuals achieve lasting health benefits. Baptist Health Bariatric Center offers the lat-est and safest weight loss surgery options:

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1. Bariatric Clear Liquids: starts the day after surgery. 2. Bariatric Full Liquids: starts the day you go home from the hospital. 3. Bariatric Pureed Food: starts at your 2-week post-op clinic visit. 4. Bariatric Soft Foods: lasts about 2 weeks for Bypass and 4 weeks for the Sleeve. 5. Bariatric Regular diet: Begins at your 2-month post-op .

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Improvement in mortality after bariatric surgery 72 1.21 Resolution of co - morbidities after bariatric surgery 73 1.22 Bariatric surgery leads to an improv ement in glucose homeostasis 74 1.23 The economic costs of obesity can be counteracted by obesity surgery 75 1.24 Our hypoth

Bellevue Bariatric Program February 2019 Lactose Intolerance and Sensitivity after Bariatric Surgery by Kat Cozza , PA-C Patients who have had bariatric surgery may experience a varie-ty of gastrointestinal changes. In particular, some bariatric by- pass patients may experience GI symptoms due to an intoler-ance or sensitivity to lactose found .

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