The process of properly preparing for gastric bypass or lap band surgery is essential for success.

Make an appointment for an initial consultation.

This will be an in-depth consultation so be prepared! Prior to your appointment you will receive a New Patient Packet including a detailed questionnaire. All the questions are important as many of your answers are needed for documentation when writing to your insurance company for approval of the surgery.

Please answer all the questions in complete detail, especially regarding the diet history portion. The diet history is critical information with regards to obtaining authorization from your insurance company.

We request that you bring with you any documentation of weight loss effort, especially all progress notes from your Primary Care Physician (PCP) or any other providers showing medically supervised weight loss efforts. Most insurance companies require documentation of at least a 6-month consecutive period. Some insurance companies will require a letter of recommendation from your PCP.

Once you are examined and it is determined that you are a candidate for surgery, a letter is written to your insurance carrier detailing the surgery to be performed.

This letter includes documentation of your height and weight, BMI, lists the medical necessity for the surgery, and describes your previously unsuccessful attempts to lose weight.

The purpose of the letter is to ask for prior approval for surgery. This is done for your protection. The cost of this type of surgery can run in excess of $30,000 (thirty thousand dollars). The written prior approval letter confirms that the Gastric Bypass surgery is a covered expense under the guidelines of your insurance policy.

On the average, it takes about four to six weeks to hear back from an insurance company. Again, for your protection, this office requires written, prior approval from your insurance company before we will schedule surgery. Verbal "OKs" are not acceptable. In addition, we will be asking whether any pre-existing condition clauses are in effect that would mean the insurance company is not liable to pay for the surgery. We will also check to see whether a second opinion is required.

If your insurance company requires a second opinion, you will be referred to a general surgeon located here in Ocala. If the insurance company requires a second bariatric surgical opinion, then arrangements will be made for you to be seen by a bariatric physician in either Gainesville, Orlando, or Jacksonville.

All patients will be sent for a psychological evaluation prior to surgery.

This is to be sure you are comfortable with the lifetime changes that are brought about by surgery. Also, as you lose weight, should you begin having problems coping, you will already be established with a health professional that can help. Our program now provides psychological consults post operatively prior to being discharged home.

After the prior approval letter is received, your surgury can be scheduled

Unless otherwise stated in the letter, most prior approval letters are valid for three months. You will be notified by letter of your surgery date, and hospital. You will also be notified of your pre-operative office visit appointment with Dr. Jawad.

During that visit, he will review the surgery, perform a pre-surgical physical, write your surgery orders, and review your diet instructions. Plan at least 3-4 hours for this appointment. You will also go to the hospital on this day for pre-admission and pre-admission testing. The whole process will probably take up most of your day.

The day before surgery, eat a light breakfast, then only clear liquids for the rest of the day. You will be instructed to drink milk of magnesia at 4pm then again at 8pm. Then you should not eat or drink anything after midnight.

Admission to the Hospital

You will be admitted to the hospital about two hours prior to surgery. The surgery process takes about one hour. If you have had a previous abdominal surgery it may take longer. Family members and friends will be kept informed on how you are doing by Dr. Jawad, his nurse, or one of the operating room nurses. After the surgery, you will be transferred to recovery for approximately two more hours then you will be transferred to the floor.

Surgery

After you are anesthetized (put to sleep) on the operating table, an NG tube and a foley (bladder) catheter are put in place. The NG tube and catheter are removed early the next morning. You will receive your pain medications through the IV line. You will also have one drain tube that you will go home with; a G-tube. These will be explained in more detail during the pre-op visit.

The day after surgery

You will be tested with Methylene Blue to determine whether there are any leaks at the anastomosis sites (where the intestine was cut and resewn). Once this is done and there are no problems, you will be given clear liquids.

Your stomach pouch will only hold one ounce at a time; therefore, you will need to sip slowly, stopping to rest at the first sign of fullness. Remember, it will take 5 minutes for the liquids to empty from the small stomach pouch to the intestines. It is important to try to drink all of your liquids to prevent dehydration. Once you are able to drink enough fluids comfortably, the IV line will be removed.

If you are doing well, you may be discharged to home by that evening. During your discharge instructions, the nurse will schedule you for a follow up appointment in our office to have your staples removed. If you are having any problems consuming enough of the right kinds of fluids, we will be able to help you at that time. Feel free to call our office between office visits if you have any problems or questions.

After you are on clear liquids for 48 hours and are tolerating them well, your diet may be advanced to a full liquid diet. This is the diet that our dieticians will inform you of in detail prior to discharging you home.

Going Home

You will need to make arrangements to have someone bring you home from the hospital, and you will probably need minimal assistance in the home for the next couple of weeks. If surgery is done laparoscopically, you will have six to seven small incisions closed with stainless steel staples. Your incision, if surgery is done open, extends from just under your breast bone down to the navel and is closed with stainless steel staples. A G-Tube will be in place which will require cleaning around the tube and cleaning, emptying 2/3 times a day or, as needed . The staples do not need special attention. You will be able to shower. Be sure to wash the incisions with soap, allowing the shower water to cleanse the area, then pat dry. Wear loose fitting dresses or shirts.

You will be restricted from driving until you return to your first post-op appointment. Therefore, you will need to make arrangements for someone to bring you to your first post-op office visit. Be sure to walk as much as possible once you get home. This will improve your circulation and will help prevent blood clots from forming causing a pulmonary embolism. It will also be important for you to do deep breathing exercises to prevent pneumonia.

If surgery is done open, you will be limited on the amount of activity you can do during the first six weeks. You should not do any heavy lifting (limit of 5 pounds), no pushing, pulling, or straining. Plan to be off from work for six weeks post-op if an open surgery is done. Depending on the type of job you do, some people feel up to returning to work part-time at three weeks post-op. An early release to work can be given with lifting restrictions.

If surgery is done laparoscopically, normal activity may be resumed in about two weeks. Many patients are able to return to work full time in 1-2 weeks if your job is sedentary.

One Week Post-Op

Before you leave the hospital, you will be given an appointment to return to the office one week after your discharge or two weeks post-op. The staples on your abdomen will be removed at this time. You will be given a one month appointment, then two month appointment, and then a three month appointment to be seen in Dr. Jawad's office to monitor your diet progression, your weight loss, and your health as it relates to your weight loss. Dr. Jawad will then follow up with you every six months for the rest of your life to monitor your blood work for iron, calcium, B12, and protein and to check your weight status.

At your first post-op visit, you will be given a prescription for your vitamins, minerals and liquid iron. Your food diary will be reviewed to see whether you are consuming enough protein and fluids.

Four-Six Week Post-Op

You will be advised to begin your mechanical soft diet. This diet consists of foods which are very soft in texture, can be mashed on your plate, and are easy to digest. You will also be advised to begin eating three meals a day with milk or other high protein foods as an in between meal snack.

Your stomach pouch will still only hold one ounce of food at a time. The solid foods will pass more slowly than the liquids you have been consuming. It is important to learn to eat slowly, stop eating once you feel full and give time for the foods to be digested before finishing your meal. Continue to keep an occasional food record of how much and what you are eating and drinking, so we can help you with meal planning if needed.

Eight Week Post-Op

You will be fully able to begin a moderate exercise program. Whatever exercise you were` able to do prior to surgery, you should be able to attempt now. The best form of exercise for you will depend on your physical condition and degree of obesity. Walking, stationary bikes, treadmills, and aquasize are good places to start.

At eight weeks post-op, you will be advanced to a regular weight reduction diet. It is very important you continue to eat three meals a day preferably, no snacking between meals. You should be able to eat all foods except those high in sugar. Keeping a three day food record at least once a month is a good idea, to help you understand how many calories and grams of proteins you are consuming.

Your weight loss will begin to stabilize at this point. How much weight you lose each month will depend on your height, weight, age, sex, and activity levels. Your eating habits will also determine how much weight you will lose. Finding a good scale that will weigh you consistently each week is difficult. Feel free to come by the office and weigh yourself. It is best to weigh yourself no more than once a week. For most people, a monthly weigh-in will be adequate.

Many patients try to compare their "success" based on how others are doing or have done. While it is important to set up friendships with other Gastric Bypass patients for the emotional support and advise, remember, you can only measure your success based on how you are doing. Trying to meet or beat others' weight loss schedules will set you up for potential failure, discouragement, and despair.

Three Month Post-Op

You will be fully healed and can perform any work or exercise program that is within your physical capabilities. Beginning a routine exercise program is highly recommended as part of your longterm weight loss and weight maintenance program. Not only will exercise help raise your basal metabolic rate and help you to lose weight fast, it will tone your muscles. Exercise will not cause your skin to shrink back into shape.

Depending on how overweight you are, how long you have been overweight, and your age, your skin will begin to "sag" as you lose weight. Although some peoples' skin will tighten up within a year after their weight loss, most people will develop an abdominal apron or they will notice sagging skin on their upper arms, thighs, or throat. This can be corrected with plastic surgery.