Weight Loss Surgery Questions

My Weight Loss
Surgery Questions

21-30

21. What is the average total lb. lost and loss maintained of Dr. Johnell’s patients? Example: average person loses 100 lb. and maintains 80 lb. loss long-term. Is it realistic that I could lose enough to get to 160 and actually maintain at 180 long-term??

Averaging pounds of weight loss is inappropriate. A 575 pound man might lose 300 lbs. overall, whereas someone who is only 100 lbs. overweight will lose only 80 lbs. We haven't seen any weight regain yet because this phenomenon occurs usually after 4-5 years post-op.

22. Once the insurance approves the surgery, is there a time limit for the surgery to be performed?

Yes, insurances have a time limit on how long they will approve the procedure before you must resubmit the request. I have heard 2 months, and 3 months.

23. I read that you shouldn’t drink carbonated beverages after WLS. Is this a lifetime restriction? Is it okay if you let them go flat first?

Some patients are able to drink carbonated beverage after the initial pouch growth period (4-6 months), but most patients cannot tolerate the carbonation. On occasion, I have been able to trace eating problems and epigastric discomfort back to soda when patients did not make the connection! Yes, you can make the soda go flat, in fact, the hospital serves flat diet Sprite on the bariatric diet trays.

24. Are sugarless beverages, foods, etc. okay after WLS? Such as things sweetened with Splenda or Nutrasweet, etc.?

After gastric bypass surgery, patients must substitute surgary drinks with those sweetened with artificial sweeteners due to the propensity for simple sugars to trigger the dumping syndrome. All of the artificial sweeteners are okay to use. We recommend that patients undergoing gastric banding (Lap-Band) use artificial sweeteners despite the fact that they can eat sugar, to decrease calorie intake. Spenda, Sweet N Low, Equal, and fructose-based sweeteners are tolerated well.

25. I love to eat ‘snow cones’...crushed ice (made with an electric ‘snow cone maker’) with Splenda-sweetened, flavored syrup on it (made by DaVinci). How much crushed ice could I eat at one time after WLS?

After the initial recovery period in post-op gastric bypass, patients are usually able to eat ice. I have however, had some patients describe a feeling much like the dumping syndrome after drinking ice cold liquids.

26. How common is vomiting and/or diarrhea after WLS of this type? Years ago, I remember reading and hearing about people having ‘stomach stapling’ procedures and then having terrible diarrhea and vomiting the rest of their lives.

The simple "stomach stapling" procedure you describe is not usually associated with problems of vomiting or diarrhea. The Jejuno-ileal Bypass (one of the original bariatric procedures, which has been abandoned as a viable WLS) was associated with diarrhea, electrolyte imbalances, liver failure, and osteoporosis. Biliopancreatic Diversion is associated with occasional diarrhea and multiple BMs throughout the day. Vertical Banded Gastroplasty is sometimes associates with vomiting and gastric reflux. We rarely see vomiting or diarrhea with the gastric bypass or the Lap-Band.

27. What about if you get the stomach flu? Are you actually able to vomit as you did before the surgery? Do you require special medical treatment if you get this type of illness after the WLS?

Patients who get the stomach flu after bariatric surgery are pitiful! On the discharge instruction sheet we give you in class (and you get at the hospital upon discharge) it states that you should stay away from people who are sick, and children whether sick or not. Children may be carriers of viruses when they are not obviously ill. In some cases, patients have had to come in to Urgent Care of the ER to get re-hydrated after vomiting with the stomach flu. We always prescribe anti-nausea medication for any patients who are vomiting.

28. I’ve read on the listservs of some people wearing Medic-Alert bracelets after WLS. Do you recommend this? Why or why not? If I got one, what should it say in regards to the WLS?

Medic-Alert bracelets are probably not necessary after WLS. It is only in the early post-op period that the stomach (pouch) is especially vulnerable. You have to be the verbal medic-alert for yourself if for example, a radiology technician tells you that you have to drink 12 ounces or radio-opaque fluid!! If a doctor in the emergency room wants to put a naso-gastric tube down into your stomach, you will have to tell them about your surgery. Patients in the early post-op period should have NG tubes inserted under fluoroscopy in radiology.

29. I read in your material that you must take vitamin supplements the rest of your life after WLS. Are these special prescriptions that you purchase through your health insurance, or do you have to get over-the-counter? Some of those are very large pills…do some of them come in liquid form to make them easier to take after the surgery?

The supplements after gastric bypass are described in detail in the pre-op class. We are very specific about what we want you to take, how large the pills are, how much, and how often supplements are to be taken. Liquid vitamins are ok once "cleared" for their adequacy...but most patients cannot stand the taste of them. Most of these are over-the-counter, but you may get a break on the iron if your insurance covers this.

30. I have neuropathy in my feet that is getting continually worse. I’ve heard that Vitamin B-12 can help this. Do you know if that is true? Do you think losing the excess weight and keeping it off could reverse the neuropathy?

I have not read any literature describing improvement in diabetes induced neuropathies after gastric bypass surgery...and so far, our patients with neuropathies have not seen any improvement. I am hopeful though! All of the B vitamins help nerve tissue. I would take 100 mg Vitamin B Complex pre-op, and the usual regimen we prescribe after surgery.

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mossman2@attbi.com
Last updated on 11/1/02