Monthly Archives: November 2015

Obesity Surgery

What is the cost of this operation?

Please contact us and take care to fill out the insurance coverage verification portion of the form.

Will my insurance cover this operation?

Most health insurance companies will cover most of this surgical procedure. However, there are so many plans that it is best to contact us and to schedule an appointment.

How safe is this operation?

Like every operation, there is a risk. Because our patients already have health-related problems, there is an increased risk of complications. However, our team makes sure the thoroughly screen you to make sure that there are no surprises on the operating table. If we feel that it is not safe to operate on you, we will not proceed. However we will gladly work with you in order for you to be eligible for the operation. Your team will be behind you 100% before, during, and after the surgery.

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What is Obesity?

Obesity results from the excess accumulation of fat that exceeds the body’s skeletal and physical standards. According to the American Obesity Association, Obesity is a disease.

What is Morbid Obesity?

Morbid Obesity is typically defined as being 100 lbs. or more over ideal body weight, or having a BMI (Body Mass Index) of 40 or higher. Morbid Obesity reaches a point of significantly increasing the risk of co-Morbidities that result in either significant physical disability or even death. Morbid Obesity is a serious and chronic disease. Treatment is available, and surgery is an extremely viable option for you.

Skin integrity is essential for the operative site. It’s important to maintain good hygiene, by keeping skin clean and dry, especially in the days before surgery.  Skin breakdown could possibly cause your surgery to be delayed.

It is important to avoid aspirin and all aspirin-based medicines for at least 10 days prior to surgery.  Herbal medications such as St. John’s Wort, Gingko Biloba, garlic, etc. should be avoided, as these have blood-thinning properties.  Other herbal supplements such as kava and valerian root are known to interact with anesthesia and should also be stopped at least 10 days prior to surgery.

Remember to tell your surgeon all of the medicines and herbal supplements you are taking. Do not forget to check the label of your multivitamin, as many can contain herbal supplements as well. Remember to check all labels of over-the-counter medicines, since certain ones can contain aspirin, too. When in doubt, please check with your pharmacist and/or surgeon.

Bariatric Surgery

After Surgery

  1. Recovery
  2. The hospital stay for bariatric surgery averages two to five days, longer for those with complications. Patients undergoing the laparoscopic method usually have a shorter hospitalization period.
  3. When you return to your room after surgery, you will continue to be closely monitored by your nurses. The first few days after the operation are a critical time for you to heal.
  4. Along with periodic monitoring of your vital signs (blood pressure, pulse, temperature, respirations), your nurses will encourage and assist you in performing deep breathing, coughing, leg movement exercises and getting out of bed after surgery. These activities can help to prevent complications.
  5. Be certain to report any symptoms of nausea, anxiety, muscle spasms, increased pain or shortness of breathing to your nurse.
  6. To varying degrees, it is normal to experience fatigue, nausea and vomiting, sleeplessness, surgical pain, weakness and light-headedness, loss of appetite, gas pain, flatulence, loose stools ad emotional ups and downs in the early days and weeks after surgery. You may discuss specific medical concerns with your surgeon.

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  1. 2. Pain Control
  2. You may feel pain where the incision was made or from the position your body was in during surgery. Some patients may also experience neck and should ear pain after laparoscopy. Your comfort is very important to your medical team. Although there will always be some discomfort after an operation, keeping your pain under control is necessary for your recovery. When you are comfortable, you are better able to take part in activities such as walking, deep breathing and coughing, all of which are imperative in order to recover as quickly as possible.
  3. If you are feeling pain after surgery, you will be able to push a button on a cord to administer pain medication to yourself. This method of administration is called “patient-controlled analgesia” (PCA). As soon as you are able to tolerate fluids, you medical team will add oral pain medication.
  4. Please remember that you are not bothering the staff if you are asking for pain medicine! Your nurses and doctors will ask you to pick a way that you can describe your pain.
  5. Two helpful ways to describe the pain include the number scale (0 to 10 scale; 0= no pain; 10= the worst pain possible) or you can use the words (none, mild, moderate, severe).
  6. No matter what form of pain control you receive, PCA or pill, here are some pointers to help you become more comfortable:
  7. Tell your nurses and physicians if you are having pain, particularly if it keeps you from moving, taking deep breaths and generally feeling comfortable
  8. Everyone is different, so keeping your nurses informed about how you feel will help them help you

iii. Plan ahead for pain; if you are comfortable lying down, you may still need a pain medication to get up and walk around

  1. Keep ahead of the pain. Don’t wait for the pain to be at its worst before you push the PCA button or ask for pain medicine. Pain medication works best when used to prevent pain
  2. The risk of becoming addicted to pain medicine is very low when it is used for a specific medical purpose, such as surgery
  3. Exercises That Help to Speed up Your Recovery
  4. Changing positions in bed, walking and prescribed exercise promotes circulation. Good blood flow discourages the formation of blood clots and enhances healing. Getting up, walking and doing your post-operative exercises may help to speed up your recovery and minimize complications.
  5. Note: The exercises we’re about to describe should be repeated at least once every hour after surgery, but it is also a good idea to practice them before surgery in order to help increase lung function and agility.
  6. With the help of your nurse or physical therapist, you should sit up and dangle your feet the first night of surgery and stand at your bedside. Yes, it may hurt but each time you get out of bed it will get easier. Each day you will notice your strength returning, with less and less pain. You will be asked to get out of bed and walk the first post-operative day. After that, you will be required to walk at least three times per day and perform your leg and breathing exercises hourly. You may not feel well enough to go for a walk, but it is very important that you try your best and do as much as possible.
  7. Your nurse will instruct you in coughing and deep breathing, and you will be shown how to use an “incentive spirometer” to help you expand your lungs. Coughing and deep breathing is important so that you will loosen any secretions that may be in your throat or lungs and to help prevent pneumonia. Deep breathing also increases circulation and promotes elimination of anesthesia.
  8. The proper way to deep breath and cough is to follow these steps:
  9. Inhale as deeply as you can
  10. Hold breath for two seconds

iii. Exhale completely

  1. Repeat the above steps three times
  2. Inhale deeply
  3. Cough. The cough should come from the abdomen, not from your throat: hold your pillow on your abdomen for support
  4. The proper way to exercise your feet and legs is to follow these steps;
  5. Push your toes of both feet toward the end of the bed (as if you’re pressing down on a gas pedal)
  6. Pull your toes toward the head of your bed, and then relax

iii. Circle each ankle to the right, then to the left

  1. Repeat three times

Medical Weight Loss California

Preparing for Surgery & Procedure

The Day Before

  • Bowel Preparation before Surgery
  • You will be given instructions for bowel preparation at your pre-operative appointment. It is important that you follow these instructions completely.
  • The day before surgery, you may drink only clear liquids. Clear liquids include water, coffee, tea, apple juice, grape juice, cranberry juice, bouillon, broth, clear popsicles, clear soda and gelatin.
  • After midnight the day before your surgery, you must take nothing by mouth except medicines that have been approved by the anesthesiologist and surgeon. Your stomach must be empty at the start of the procedure to reduce the risk of aspiration.
  •  If You are ill Before Surgery
  • Should you develop a cold, persistent cough, fever, skin breakdown or any changes in your condition during the days before your surgery, please notify the surgeon immediately, as you will need to be re-evaluated for surgical readiness. You need to be in the best possible shape for anesthesia. Scheduling can be adjusted to your condition, if necessary.

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The Day of Surgery

Personal Preparation

  • We recommend that you shower in the morning on the day of surgery, but do not use any moisturizers, creams, lotions or makeup. Remove your jewelry and do not wear nail polish.
  • You may wear dentures, but you will need to remove them just prior to surgery.

What to bring to the Hospital

  • It is recommended to bring only the bare necessities to the hospital. Do not bring any jewelry or more than $20 cash. You may want to bring a picture of a family member, friend or pet to help you relax.
  • There are a few other things that may make your stay a little more comfortable:
  • This guide
  • A small overnight bag with toiletries such as toothbrush, toothpaste, soap, shampoo and lotion
  • Your eyeglasses and a case, if possible
  • Protective storage cases(s) for corrective lenses, dentures, hearing aids, etc.
  • Bathrobe
  • Address and phone book of loved ones
  • Lip balm
  • Comfortable, loose-fitting clothes to wear when you go home. Clothes that are easily removed and easy to slip on are the best
  • Hospital Pre-admitting Procedure
  • Before you can have your surgery, you will need to follow your hospital’s policy on pre-admission testing and registration. Specific instructions will be given to you by your hospital or surgeon’s office.
  • After you are registered and checked-in, you will be asked to change your clothing and put on a hospital gown and slippers. If you wear dentures, corrective lenses or hearing aids, you will be asked to remove them for safety reasons, so it’s best to bring your own container for storing each of these items.
  • You will be asked to sign an operative consent form, even though you may already have done so at your surgeon’s office. Your signature indicates that the procedure has been explained to you, that you understand it and that you have no further questions.
  • Your blood pressure, pulse, respiration, oxygen saturation, temperature, height and weight will be measured. An intravenous (IV) line will be placed in your forearm. This allows fluids and/or medications into your blood stream. You may also be given some medicine to help you relax.
  • Anesthesia
  • When general anesthesia is used, you will be sound asleep and under the care of the anesthesiologist throughout the operation. Many patients have an instinctive fear of anesthesia. The sophisticated monitoring system now used makes a recognition and treatment of problems with anesthesia almost immediate. A minute change in the oxygen level in you blood, in the amount of carbon dioxide you breathe out, in your heart rate or in your blood pressure would be reported immediately.
  • Your anesthesiologist will discuss the specific risks of general anesthesia with you before your surgery.
  • The Operating Room
  • Going to the operating room (OR) is not a normal experience for most of us. Your surgical team recognizes the natural anxiety with which most patients approach this step in the process to achieving their goals. We believe that a description of the surgical experience will help you prepare for it.
  • Specialists using the most modern equipment and techniques possible will attend to you. This team includes at least one board certified anesthesiologist, a trained surgical assistant and nurses that will assist your surgeon. A registered nurse is in charge of the OR.
  • Once you enter the OR, the staff will do everything they can to make you feel secure. You may walk to the OR be transported on a gurney (a bed or stretcher on wheels). There, the nurses who will be assisting your surgeon will review your chart.
  • Once you are settled on the operating table, you will be connected to several monitors and an intravenous (IV) catheter. A quick acting sedative will be given through the IV tubing after you have breathed pure oxygen for a few minutes. Once you fall asleep, your anesthesiologist will usually slip an endotracheal tube through your mouth into your windpipe to guarantee that your breathing is unimpeded. An anesthetic gas and other medications will keep you asleep and pain free. At the same time, the anesthesiologist will connect you to monitoring devices.
  • After you are asleep, a small plastic nasogastric (NG) tube is placed through your nose into your stomach, and another tube called a urinary catheter into your bladder.
  • The surgery will last about two hours to three hours, but the length of the operation is dependent on the type of procedure(s) performed, number of extra procedures necessary, if any and the difficulty of finding working space within a very large abdomen.
  • When your surgery has been completed and your dressings are in place, you will be moved to the recovery room.