1. Care of the Bariatric Patient February 15, 2012
Nursing Grand Rounds
Care of the Bariatric Patient
February 15, 2012

2. Presented and Planned by:
Needham 3:
Jessica Kaloyanides, RN
Marjorie Petit, RN, BSN
Kayleen Sussman, RN
Kelly Donahue, RN, BSN
Operating Room:
Eric Starble, RN, BSN, CNOR
Leslie Schneiderhan, RN, BSN, MEd, CNOR
Al Ghilardi Orthopedic Tech Photography
Weight Management Center:
Lisa C. Luz, RN, MSN, CBN
Nutrition:
Dana Eiesland, RD, LDN
Stacey A. Nelson, BS, RD, LDN

3. 40.0 and higher Morbid obesity
Obesity is defined as having an excessive amount of body fat.
Doctors often use Body Mass Index to determine obesity
BMI Weight status
Below Underweight
Normal
Overweight
30.0 and higher Obese
40.0 and higher Morbid obesity

4. Obesity in the US
About one-third of U.S. adults (33.8%) are obese. (Center for Disease Control and Prevention)
During past 20 years there has been a dramatic increase in obesity in the United States

5. The Dangers of Obesity Obesity results in many co-morbidities such as:
sleep apnea
joint disease
hypertension
stroke
diabetes
respiratory diseases
World health organization estimated that being overweight and inactive accounts for ¼-1/3 of all cancers of the breast, colon, endometrium, kidney, and esophagus

6. Obesity Attitudes in Health Care
self-report studies show that physicians, nurses, and other medical personnel view obese patients as:
non-compliant
lazy
dishonest
lacking in self-control
unsuccessful
sloppy

7. Surgical Weight Management
4/6/2017
Surgical Weight Management
Lisa C. Luz, RN, MSN, CBN

8. Surgical Weight Management
Under the direction of expert bariatric surgeons:
Julie Kim, MD, FACS
Associates from TMC:
Dr. Abeles, Dr. Shah, Dr. Tarnoff, fellows
Multidisciplinary Team
Dietitian
Psychologist
Program Coordinator/Nurse
Insurance Specialist

9. Who is a Surgical Candidate?
Meets National Institutes of Health Criteria:
BMI > 40
>35 with significant obesity-related co-morbidities
18 years or older
No endocrine cause of obesity
Stable psychological condition
Absence of drug or alcohol problem/Non-Smoking
Understands surgery and risks
Acceptable operative risks (patient and procedure)
Consensus after bariatric team evaluation:
psychologist, dietitian, surgeon
Dedicated to lifestyle change and follow-up

10. The Surgical Process Information Session Immersion Day
Preliminary Application
Health History Questionnaire
Immersion Day
Psychologist/Behavioral Assessment
Nutritional Counseling
Medical Clearance from PCP or Specialist
Medical Testing: Labs, X-ray, EKG
Consultation with Surgeon
Support Groups
Insurance Approval

11. The Surgical Process Mental Health Evaluation Preparing for new Life
Identify the support needed to be successful
Individual Nutrition Appointments
Minimum 2 visits (for insurance approval)
Individual Diet Planning and Education
Medical Testing
Labs, Chest X-ray, EKG and any testing TBD by team

12. The Surgical Process This process takes approximately 3-6 months!
Surgical Consultation
One on One consultation to answer all questions and individual concerns
Medical Clearance
By PCP, or specialist
Support Groups~ Make the Difference
This process takes approximately 3-6 months!

13. Bariatric Surgery Eric Starble RN
4/6/2017
Bariatric Surgery Eric Starble RN

14. Review of the Digestive System
4/6/2017
Review of the Digestive System
Esophagus
Stomach
Small Intestine (Duodenum, Jejunum, Ileum)
Large Intestine
Describe both function and size.

15. Bariatric Surgery Today
4/6/2017
Bariatric Surgery Today
Three Types of Most Commonly Performed Bariatric Surgery Procedures
Malabsorptive
Restrictive
Combination
Currently, there are three types of bariatric surgeries being performed:
Malablsorptive, where weight loss is due to absorptive dysfunction caused by the reconstruction of the small intestines – the biliopancreatic diversion is considered a malabsoptive procedure.
Restrictive procedures, such as banding, simply limit the size of the stomach. The patient loses weight because they will feel full or satiated after consuming very little food.
In combination procedures, such as a Roux-en-Y Gastric bypass, the size of stomach is reduced by creating a small pouch, but the small intestines are also altered to limit absorption, particularly the absorption of foods high in fat and in carbohydrates.
Biliopancreatic Diversion with Duodenal Switch
Adjustable Band Gastroplasty
Roux-en-Y Gastric Bypass

16. Adjustable Band Gastroplasty
4/6/2017
Restrictive Surgery
Relatively easy surgical procedure
Less dietary deficiencies
Less weight loss
More late failures due to dilation
Less effective with sweet eaters
Significant dietary compliance
Approved by the FDA in June 2001, the BioEnterics® LAP-BAND® Adjustable Gastric Banding System is the newest and the only adjustable surgical treatment for morbid obesity in the United States. It induces weight loss by reducing the capacity of the stomach, which restricts the amount of food that can be consumed.
Since there is no cutting, stapling or stomach rerouting involved in the LAP-BAND System procedure, it is considered the least traumatic of all weight loss surgeries. The laparoscopic approach to the surgery also offers the advantages of reduced post-operative pain, shortened hospital stay and quicker recovery. If for any reason the LAP-BAND System needs to be removed, the stomach generally returns to its original form.
The most frequently occurring complications associated with the LAP-BAND (INAMED Health, Santa Barbara, CA) include gastric prolapse, stoma obstruction, esophageal and gastric pouch dilatation, erosion, and access port problems.
Adjustable Band Gastroplasty

17. Malabsorptive Surgery
4/6/2017
Malabsorptive Surgery
Greater sustained weight loss with less dietary compliance
Increased risk of malnutrition and vitamin deficiency
Constant follow–up to monitor increased risk
Intermittent diarrhea
The immediate result of the surgery is a restriction of food intake due to the smaller stomach size; this assists the initial weight loss. Within 18 months the stomach pouch will gradually stretch to hold a normal-size meal. Weight loss will taper off and stabilize. An added benefit of stomach size reduction is decreased stomach acid production, thereby reducing the chances of ulcer formation.
Additionally, fewer calories are absorbed in the abbreviated 30-inch section of small bowel where food and digestive juices combine. This results in continued weight loss due to malabsorption. In the first 18 months after surgery, fats are incompletely absorbed, proteins are somewhat more absorbed, and simple sugars are completely absorbed. As the bowel naturally accommodates the surgery, fats will continue to be incompletely absorbed, but both protein and carbohydrate absorption generally increase over time.
WEIGHT LOSS RESULTS:
Drs. Robert Rabkin and John Rabkin have performed over 900 duodenal switch surgeries through August 2002 (including open and laparoscopic procedures). The initial results for all laparoscopic patients are as follows:
Average excess weight loss at 3 months is 29%.
Average excess weight loss at 6 months is 51%.
Average excess weight loss at 24 months is 91%.
Biliopancreatic Diversion with Duodenal Switch

18. Laparoscopic Sleeve Gastrectomy
Restrictive procedure
Purpose: Suppression of hunger hormones
No intestinal connection
Considered a standard procedure by national society (ASMBS)
Newer procedure
Covered by many but not all insurance companies

19. Mechanics of Sleeve Gastrectomy
Permanent removal of the lateral portion of the stomach
Creates a long, narrow, "banana" shaped stomach or "sleeve"
Reduces the capacity of the stomach by 2/3rds
No foreign body or needle sticks required
The body's natural pyloric and gastroesophageal valve act to restrict the passage of food with removal of many of the hunger hormones

20. Laparoscopic Sleeve Gastrectomy

21. Roux-en-Y Gastric-Bypass
4/6/2017
Roux-en-Y Gastric-Bypass
Long-term sustained weight loss
No protein-calorie malabsorption
Little vitamin or mineral deficiencies
Technically difficult procedure
The complications of gastric bypass are much less severe than those of Intestinal Bypass, and most large series report complications in two phases, those which occur shortly after surgery, and those which take a longer time to develop. The most serious acute complications include leaks at the junction of stomach and small intestine. This dangerous complication usually requires that the patient be returned to surgery on an urgent basis, as does the rare acute gastric dilatation, which may arise spontaneously or secondary to a blockage occurring at the Y-shaped anastomosis (jejunojejunostomy). Then there are the complications to which any obese patient having surgery is prone, these including degrees of lung collapse (atelectasis) which occur because it is hard for the patient to breathe deeply when in pain. In consequence a great deal of attention is paid in the postoperative period to encouraging deep breathing and patient activity to try to minimize the problem. Blood clots affecting the legs are more common in overweight patients and carry the risk of breaking off and being carried to the lungs as a pulmonary embolus. This is the reason obese patients are usually anticoagulated before surgery with a low dose of Heparin or other anticoagulant.
Complications which occur later on after the incision is all healed, include narrowing of the stoma (the junction between stomach pouch and intestine), which results from scar tissue development. Recall that this opening is made about 10 mm in diameter, not much wider than dime. With an opening this small, a very little scarring will squeeze the opening down to a degree that affects the patients eating. Vomiting which comes on between the 4th and 12th week may well be due to this cause. The problem can be very simply dealt with by stretching the opening to the correct size, by endoscopic balloon dilatation, which usually involves a single procedure on a day stay basis to correct the problem. Wound hernias occur in 5-10% and intestinal obstruction in 2% of patients an incidence similar to that following any general surgical abdominal procedure.
Another late problem which is fairly common, especially in menstruating women, after gastric bypass is anemia. Since the stomach is involved in iron and Vitamin B12 absorption, these may not be absorbed adequately following bypass. As a result anemia may develop. The patient feels tired and listless, and blood tests show low levels of hematocrit, hemoglobin, iron, Vitamin B12. The condition can be prevented and treated, if necessary, by taking extra iron and B12. Since the food stream bypasses the duodenum, the primary site of calcium absorption, the possibility of calcium deficiency exists, and all patients should take supplemental calcium to forestall this.
Dumping is often mentioned as a complication of gastric bypass, but it really is a side effect of the procedure caused by the way the intestine is hooked up. Dumping occurs when the patient eats refined sugar following gastric bypass, this causes symptoms of rapid heart beat, nausea, tremor and faint feeling, sometimes followed by diarrhea. Of course no one likes these feelings, especially patients who love sweets! The upshot is, of course, that sweet lovers avoid sweets after gastric bypass and this is a real help to them in their efforts to lose weight. It should be noted that a few surgeons, expert at endoscopic/laparoscopic surgery, are performing Gastric Bypass using laparoscopic techniques. Listing of complications following gastric bypass:
Early:
Leak
Acute gastric dilatation
Roux-Y obstruction
Atelectasis
Wound Infection/seroma
Late:
Stomal Stenosis
Anemia
Vitamin B-12 deficiency
Calcium deficiency/osteoporosis
Roux-en-Y Gastric Bypass

22. The Roux-en-Y Gastric Bypass
4/6/2017
The Roux-en-Y Gastric Bypass
A small, 15 to 20cc, pouch is created at the top of the stomach.
The small bowel is divided. The biliopancreatic limb is reattached to the small bowel.
The other end is connected to the pouch, creating the Roux limb.
In the United States today, the Roux-en-Y gastric bypass is the gold standard for weight loss surgery.
When performing the procedure,
1. A small, 15 to 20 cc, pouch is created at the top of the stomach.
2. The small bowel is divided. The biliopancreatic limb is re-attached to the small bowel.
3. The other end is connected to the pouch, creating the Roux limb
The small pouch releases food slowly into the Roux limb, causing a sensation of fullness with very little food.
The biliopancreatic limb preserves the action of the digestive tract.
Roux-en-Y Gastric Bypass

23. Roux-en-Y Gastric Bypass
Small pouch releases food slowly, causing a sensation of fullness with very little food
Biliopancreatic limb preserves the action of the digestive tract

24. Open and Laparoscopic Technique in Bariatric Surgery
4/6/2017
Open and Laparoscopic Technique in Bariatric Surgery
Open
Increased post op pain, longer hospitalizations
Increased incidence of wound complications - infections, hernias, seromas
Return to work in 4-8 weeks
Laparoscopic
Less post op pain, early mobility
Wound complications are significantly reduced
2-3 day hospital stay
Return to work in 1-3 weeks
Traditional Surgery: Once the only method used for surgical procedures, traditional open surgery involves making a 10- to 12-inch incision to access the stomach and intestines. Then the surgeon performs a restriction or gastric bypass operation.
Minimally Invasive or Laparoscopic Surgery
In minimally invasive, or laparoscopic, surgery, the surgeon uses five or six small incisions (each 1/4 and 1/2 inch long) to access the stomach and intestines. The laparoscope is a probe-like tool with a video camera attached. The surgeon inserts the laparoscope through the incisions and gets a magnified view of the patient's organs on a television monitor. The entire operation is performed inside the abdomen after gas has been inserted to expand the abdomen. Surgeons continually find ways to use ever-smaller incisions, lower operative risk, reduce postoperative pain, and shorten hospital stays. Minimally invasive surgery techniques have cut recovery times for many operations from weeks to days.

25. What Happens in the OR?

26. Bariatric Surgery: Beyond the Surgery
4/6/2017
Bariatric Surgery: Beyond the Surgery
Bariatric Surgery will NOT work alone
Intricate parts of your weight loss success:
Commitment to:
Diet
Exercise
Support groups

27. Resolution of Comorbidities
4/6/2017
Resolution of Comorbidities
N=104 1 year post-op
Number Prior to Surgery
% Worse
% No Change
% Improved
% Resolved
Osteoarthritis 64 2 10 47 41
Hypercholesterimia 62 4 33 63
GERD 58 24 72
Hypertension 57 12 18 70
Sleep Apnea 44 5 19 74
Hypertriglyceridemia 43 14 29
Peripheral Edema 31 55
Stress Incontinence 6 11 39
Asthma 69 13
Diabetes 82
Average
1.6%
7.8%
35.1%
55.7%
90.8%
Improved or Resolved
Studies have also shown that there is an almost complete resolution of a patient’s obesity related comorbidities following gastric bypass surgery.
Shown here are the results from a single institution:
Philip Schauer, MD, University of Pittsburgh Medical Center
Focus on presenting a few of the key comorbidities and point out the % of the patients that either improved or completely resolved their obesity related health problems
In particular serious conditions, such as - GERD - Hypertension - Sleep Apnea and Diabetes are all improved or resolved after surgery
[columns on the right]
[moving the slide forward (with mouse click) highlights the “improved” and “resolved” areas of the slide]
Then point out that overall, 90.8% of patients had improved or resolved their obesity related comorbidities.
Schauer, et al, Ann Surg 2000 Oct;232(4):515-29

28. Possible Complications
4/6/2017
May Lead to Short or Long-term Hospitalization and/or Re-operation
Infection, bleeding or leaking at suture/staple lines
Blockage of the intestines or pouch
Dehydration
Blood clots in legs or lungs
Vitamin and mineral deficiency
Protein malnutrition
Incisional hernia
Death

29. Possible Side Effects Nausea and vomiting Gas and bloating
4/6/2017
Possible Side Effects
Nausea and vomiting
Gas and bloating
Dumping syndrome
Lactose intolerance
Temporary hair thinning
Depression and psychological distress
Changes in bowel habits such as diarrhea, constipation, gas and/or foul smelling stool

30. Post-Operative Summary
4/6/2017
Post-Operative Summary
On Average, Gastric-bypass Patients…
Lose 65-80% of their excess body weight, the majority of it in the first 18 to 24 months after surgery.
May have rapid improvements in the morbid side effects of their obesity, such as type 2 diabetes, high blood pressure, sleep apnea, and high cholesterol levels.

31. Dana Eiesland, RD, LDN Stacey A. Nelson, RD, LDN
4/6/2017
Bariatric Surgery Nutrition Education
Dana Eiesland, RD, LDN
Stacey A. Nelson, RD, LDN 31

32. Pre-Surgery Nutrition Education : Immersion Day
4/6/2017
Pre-Surgery Nutrition Education : Immersion Day
Education Provided:
Mindful eating (eating speed, environment)
Self- monitoring (keeping daily food journal)
Dietary changes to promote pre-op weight loss (ie. Meal planning, lean protein sources, snacks)
Exercise Recommendations
Post-op diet progression
Long-term food selection guidelines
Fluid guidelines
Protein supplements
Vitamin & mineral supplementation
Reading nutrition fact labels 32

33. Pre-op Bariatric “To Do” List
4/6/2017
Pre-op Bariatric “To Do” List
___ Read the Nutritional Guidelines
___ Buy everything on shopping list
___ Follow low-calorie diet
(to lose ~5% of start weight pre-op)
___ Keep daily food dairy
(Measure & weigh all food & drinks)
___ Count daily protein & fluid intake
___ Begin taking vitamin/mineral supplements
___ Practice using approved protein supplements
___ Exercise: Goal = 30 minutes most days
___ Practice eating slowly (30min/meal)
___ Practice drinking ONLY between meals; avoid drinking 30 minutes before & after eating
___ Avoid caffeine, soda, carbonation, juice, & sweetened beverages
___ Try Stage 4 (pureed & soft moist protein foods) for 2 full days
___ Attend support groups 33

34. Pre-Surgery Nutrition Education: Individual Counseling
4/6/2017
Pre-Surgery Nutrition Education: Individual Counseling
•Min. 2 individual visits with Outpatient RD
Re-enforce information provided at Immersion Day
Pre-op weight loss
Practicing portion control
Meal planning
Self-monitoring of eating & physical activity
Strategies to adopt more mindful eating habits
Increasing regular physical activity
Increasing intake of fruits/vegetables/low-fat dairy &proteins/whole grains/water 34

35. Inpatient Bariatric Diet Diet stages 1-3
Nutrition Consult ordered upon admission
Review diet progression, stages 1-3
Discuss fluid intake journal: focused on hydration, sipping slowly, 1-4 oz/hour between meals, no straws
Work with inpatient team to identify and minimize complications post-op
Confirm patient post-op RD appointment

36. Inpatient Bariatric Diet Diet stages 1-3
Stage 1: Water (provided by RN)
No straws
1oz/hr
Fluid intake journal
Stage 2: Clear Liquids (standard tray)
Non-carbonated, caffeine-free, sugar-free:
Water, diet cranberry juice, sugar-free jello and ice pops, broths, decaf coffee and tea
Stage 3: High Protein Full Liquids (self-order)
Low-fat, high protein food items:
Broth, low-fat milk, protein shakes (SF CIB), tomato soup, low-fat yogurt, and diet custard/ pudding

37. Bariatric Diet Advancement Diet Stage 4
Stage 4: Soft & Moist Protein
Start: 2 wks post-op; Duration 4-6 wks
Examples of protein sources:
Chicken salad made w/ low-fat mayonnaise
Chili made w/ lean ground turkey/beef
Moist fish/shellfish
Avoid fluids 30 min before & after each meal/snack.
Will begin taking chewable/liquid vitamin & mineral supplements.
Multi-vitamin w/ iron 200% DRI, Vit D3 1000IU, Vit B mcg, Calcium Citrate mg
Keep daily food journal.

38. Bariatric Diet Advancement Diet Stage 5
Stage 5: Low Fat, Low Sugar, High Protein
Start: 4-6 wks post-op; Duration: lifelong
Balanced solid food diet.
Continue to practice mindful eating & separate fluids from your meals.
Vitamin/Mineral supplementation for life.
For More Information on Diet Stages
Clinical Portal > Bariatric Center > Bariatric Nutrition

39. Post-Op Nutrition & Support
4/6/2017
Post-Op Nutrition & Support
Immediate (2wks- 12mo. post-op):
* Diet Advancement
* Protein & Hydration Status
* Vitamin & Mineral Status/ Supplementation
* Lifestyle and Behavior Changes
* Meal Planning & Appropriate Food Choices
Long-Term (>1yr post-op):
* Prevention of Vitamin/Mineral Deficits & Deficiencies
* Co-morbid Conditions (i.e. DM, HTN, Dyslipidemia)
* Managing Changes to Bowel Habits
* Promotion of a Balanced Diet
* Weight Maintenance & Weight Loss
* Exercise
* Promotion of Self-Care
* Lifestyle & Behavior Changes 39

40. Thank you! Dana Eiesland, RD, LDN (outpatient)
Stacey A. Nelson, RD, LDN (inpatient)
Pager: #6052

41. Postoperative Care on N-3
Jessica Kaloyanides RN
Marjorie Petit RN, BSN

42. PACU (Report from PACU RN- N3 RN
5 incisions total (one is JP drain)
100mg IV thiamine for all pts. on arrival
Hct within 2hrs : Drop of 4 points wait on transfer to floor/redraw
If vomiting or spitting up blood CALL MD
Wake to assess every 10 min during first hr
Fentanyl Dilaudid PCA
Shoulder pain/left side trocar pain ( CO2 gas in abd)
Wean O2 to NC

43. Setup of the bariatric room
Bariatric bed – holds up to 750lbs
Bariatric tray fits under each bariatric bed
Telemetry monitor with continuous 02 monitoring
Pneumatic Compression Sleeves
Incentive spirometry
Bariatric menu
Moving IV pole: pt OOB ambulating same day as surgery (unless up to floor too late)

44. Bariatric room pic (plus say pt will have lap sites)

45. Possible Complications: Anastomotic Leak
Symptoms
tachycardia
fever
abdominal pain
purulent drain output
nausea/vomiting
shoulder pain
hypotension
Treatment
surgical vs medical
stability of patient
size of leak

46. Possible Complications: Pulmonary Embolism
Symptoms
sudden SOB (active rest)
chest pain
cough with bloody sputum
tachycardia
leg swelling/weak pulse
Treatment
CXR/CCT
anticoagulant therapy
embolectomy

47. Possible Complications: Pneumonia
Symptoms
classic symptoms
sudden onset
fever/chills
coughing
chest pain
Treatment
CXR
antibiotics

48. Possible Complications: Small Bowel Obstruction
Symptoms
constipation
abdominal swelling
vomiting (green or fecal vomit)
passing jelly like mucous
abdominal cramping
Treatment
needs ABD CT/UGI
Possible IR procedure (place drain) or return to OR

49. Possible Complications: Internal Bleeding (immediately post op)
Symptoms
hypotension
tachycardia
decreased hct
bloody drainage
melena
Causes
r/t internal organ damage
r/t stapled sites

50. Possible Complications: Infection
Symptoms:
fever
foul smelling odor from lap sites/drain sites
lap sites or drain sites
yellow discharge
Treatments
antibiotics

51. General Nursing Guidelines: Activity
Pt out of bed same day as surgery
Ambulate in hallway 3x per day
Out of bed to chair as much as tolerated
IS 10x/hr while awake

52. General Nursing Guidelines
Foley DC post op day 2
PCA pump/IV fluids DC post op day 2 when pt tolerating liquids
JP drain removed by MD post op day 2
abd incisions checked Q4
VS Q4
Maintain accurate I’s/O’s

53. Bariatric Diet Stage 1: Water Typically start day of surgery NO STRAWS
Nurse to administer 1oz water per hr via med cup
Sip slowly and stop if feeling full
All meds in IV or liquid form
IV fluid until tolerating liquid

54. Discharge Instructions
Activity:
walk inside/outside
may climb stairs
avoid rigorous exercise
Pain:
use pain meds as prescribed
pain should improve over time/ call MD if pain is not under control

55. Discharge Instructions
Diet:
stage 3 diet
each meal slowly over one hour
drink at least 48 ounces of fluid per day, goal is 64 ounces per day
60-80 grams protein a day
no straws/no chewing gum
Incision Care:
adhesive will fall off on its own
if incision reddened, thick drainage or foul odor - call MD

56. Discharge Instructions
Meds:
one med at a time
cut or crush large pills
vitamins and calcium post op visit
don’t take NSAIDS until checking with MD
Contact MD If:
uncontrolled nausea or vomiting
unable to tolerate meal plan
redness, swelling or incision site/ fever of or greater
diarrhea more than 24hrs /constipation more than 5 days

57. Patient Testimonials 64 Year old female Surgery date: 7/20/2011
“My hospital experience was great. I’m very pleased with the program. I’ve done every diet and it’s gone nowhere. I was reluctant on surgery, but when I met the staff I was very impressed. I can’t say enough of Dr. Kim, she’s beyond great. Everyone was positive and reinforcing. My only regret is that I hadn’t done this sooner!”

58. Patient Testimonials 34 Year old female Date of surgery: 8/1/2011
“I’m feeling fantastic. The surgery has been a success. So far I’ve lost almost 90 pounds, and it’s the most amazing thing I’ve ever experienced. Life changing. Besides my kids it’s the most wonderful thing I’ve ever done.”

59. Patient Testimonials 51 Year old female Date of surgery: 9/26/2011
“Extremely thankful to the staff and couldn’t be happier with the surgery! I’ve lost 60 pounds. I no longer need insulin, and my hypoactive thyroid is now dormant.”

60. Post-op Care and Follow-up
Lisa C. Luz RN, MSN, CBN

61. Follow-up: Initial Post-op visits 2 weeks, 6 weeks, 3 months
Gastric Band: adjustment visit every 3-6 weeks
Labs: every three months x1 year;
then every 6 months
Annual appointments after 2 years with Medical Team
Plastic Surgery
Pregnancy
Lifetime Dietary, Behavior Modification, and Support Groups available to every patient!

62. Newsletters, website, email and telephone follow-up
Weight Loss Surgery Post-Op Care and Follow-up
Life long commitment
Support group
Nutrition classes
Exercise guidance
Guideline literature
Office visits
Newsletters, website, and telephone follow-up

63. Results of Bariatric Surgery
Improvements in overall health
Improvements in quality of life
Longer life expectancy
Resolution/Improvement of:
Type 2 Diabetes Asthma
High blood pressure Skin problems
Sleep apnea Bone and joint disease
Cancer Infertility
Heart disease Fatty liver disease
Heartburn Urinary incontinence

64. Some Surgery Truths Surgery is ONLY a tool Surgery is NOT for everyone
Surgery HAS risks
Surgery is NOT a cure but rather a treatment
Surgery does NOT FAIL the patient,
the patient fails the surgery
Long term effort and follow up
ARE ESSENTIAL for success

65. Patient Successes

66. “Rather than feel anger or revulsion toward this person, my first obligation, especially if I am in the helping professions is to understand him or her: to gain insight into what it is like to be him or her; to imagine and to interpret the world from his or her perspective of experience…”
Source: John Banja, PhD Obesity, Responsibility, and Empathy, The Case Manager, Nov/Dec 2004

67. Thank you!
Questions / Comments