Surgery for obesity & metabolic diseases

For any scheduled and elective procedure is always advisable to know the aspects that you as a patient can or should take into consideration to make a positive contribution to the evolution of both, the intraoperative and postoperative process.

Here we provide you valuable advice which will help your experience with gastric sleeve surgery to be as smooth and positive as possible.

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It is a lot of information but we think what is very convenient for you to take these tips as a good basis for your planning and to have a clearer idea about your gastric sleeve preparation.

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Keeping close contact either directly with your bariatric surgeon or at least with the patient coordinator is the basis of the success of your gastric sleeve surgery and is also the basis for all the following tips on this post.

If what you want is to achieve the best results during and after your surgery is very important that communication with the bariatric group you will choose to be as close as possible as there are many important aspects that must be considered as part of the gastric sleeve preparation process for the operation.

This will prevent the presence of misunderstandings which may affect your progress during and after surgery. Our recommendation is that you follow to the letter every recommendation they give you.

Each bariatric group manages their patients very differently and would be impossible to rely on recommendations from friends who had the surgery themselves or from forums from gastric sleeve surgery patients where everyone exposes their personal experience. It is worth knowing what others are doing but it will always be more important to stick to the instructions of who will operate you.

With theerspective that the end purpose to undergo gastric sleeve surgery is for health reasons, either because you suffer from obesity related diseases or want to avoid them, one point to consider is that if you are a smoker take this so relevant event in your life as a turning point to significantly change those habits that affect your health.

As is well known, smoking is a determinant health factor in an individual and considering that you will undergo a major surgical procedure, the recommendation is that you plan things for you to quit smoking too. This is always easier said than done but we suggest you do your best effort to quit smoking. If you make the effort and believe it will be impossible, at least we suggest you to leave it temporarily.

The ideal time to quit is a month before surgery, as it will give your body a chance to “recover” from the aggression that smoking represents to your whole body, especially your airways.

In the postoperative period is equally or even more important not to smoke, this with the intention to reduce to the maximum risks of complications in the immediate postoperative period, such as developing atelectasis (collapse of the lung) or pneumonia (lung infection).

Quitting smoking will also allow the optimal healing process of your incisions and more importantly of your stomach. Minimum recommended time to avoid smoking is again, a month after surgery.

A complication that represents the highest risk and can be due because of not quitting is the presence of a gastric leak. Cigarette makes you prone to a reduced blood flow to all of your organs including the stomach and this causes an improper healing process with possible consequent formation of a fistula (a hole in your stomach) which in most cases requires reoperation.

Therefore, ideally abandon the cigarette forever, but if you do not think you can make it, at least avoid smoking for 30 days before and 30 days after your surgery.

If you’re a “hardcore” smoker it will not help if you quit smoking the day before surgery, smoking cessation so close to the surgery may even be counterproductive because as I discussed previously the body begins to recover and the normal functions of the airways start to recover and this will cause you to have more mucus production and cough.

This does not means we suggest that if you do not stop smoking a month before is preferable that you continue to do so until a few hours before, if you could not do the 30 days before suggested, at least try one or two weeks before.

Think it would be a shame that everything turns out excellent in your surgery and you end up developing complications because of the cigarette.

In the case of alcohol, unlike the cigarette it is not so important to quit for some time before the procedure, unless you have a drinking problem and you tend to ingest alcohol regularly or on a daily basis.

If alcohol is something you consume sparingly (one glass of wine a day for example), in theory there is no need to stop it more than a few days before the procedure. But to avoid any upset stomach, it would be ideal if you stop it at least a week before the procedure.

It should be noted that alcohol (any type of alcoholic beverage), is usually high in calories and being a liquid it will easily pass through the gastric sleeve, so after the procedure you need to moderate the amount of alcohol you consume.

In addition, all patients that undergo a process of weight loss will be more susceptible to the effects of alcohol because it is metabolized in the liver, which will be very busy working and metabolizing all the fatty tissue of your body to use it as energy. So you must be careful with the amount of alcohol you drink after your surgery.

This topic is highly variable depending on which bariatric group you choose. However the general idea is the same, every patient with a significantly body mass index should undergo a preoperative diet, which should be provided by your bariatric surgeon.

For patients who do not require such preoperative diet and can eat normally before surgery, the day before the procedure it is recommended not to eat any solid food after 8 pm and no liquids after midnight . Again, this may vary depending on the surgeon you choose.

It is also important that after your gastric sleeve surgery you do a proper diet, high in protein, vitamins and minerals, with the goal of having the best health condition possible, since the surgery itself represents an “aggression” to your body so you must be prepared with proper nutritional advice.

You should avoid:

• Soft drinks, no matter the color since many people think that if the drink is clear in color they are less harmful.
• Drinks with caffeine, coffee, soft drinks, energy drinks, tea, etc. (You can replace these with decaffeinated presentations and non carbonated)

Finally a useful recommendation in relation to food and liquids is that you should start to “practice” how to ingest liquids with small sips and chew very well every bite of your food. This will greatly help you have a better mental preparation after gastric sleeve surgery, since the procedure itself will force you to do this, at least the first few weeks, and the simple fact of eating slowly is key to eat less and lose weight for the long term.

The mental/emotional preparation is also highly variable depending on the bariatric group. What we suggest as part of the preoperative evaluation is that a psychological evaluation of the patient should be performed to determine that there is no contraindication to undergo the procedure. It is important to confirm that the patient is mentally fit and ready to carry all the implications of such procedure.

Our suggestions for this will vary depending on the patient, what we seek is to always be sure that the patient is fully aware of the implications of having the surgery and has the necessary commitment to follow-up medical indications, especially in the sense of fulfillment of postoperative diet, all with the goal of minimizing the risk of complications and to have the expected results in relation to weight loss.

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Ideally the patient should be aware of all the pros and cons of surgery, and its risks. We suggest that their loved ones should get involved in the process in order to have them as allies and to receive the adequate support from them having the best possible conditions at home for the patient’s recovery.

As a suggestion, we recommend you to book an appointment with a therapist who can support you emotionally with the whole process. A professional such as a psychologist can help you become stronger mentally and emotionally for the changes that are to come before and after your surgery.

Another suggestion regarding an activity you could adopt, is to write a diary about your experience, experts always recommend that our emotions should be put on paper, this includes your goals, expectations, your dreams for the future after the procedure. After the procedure this can also help you be relaxed if you “let go” your emotions in your journal.

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Is it safe to get gastric Sleeve in Mexico

Patient’s physical preparation before gastric sleeve surgery is usually difficult to achieve since the vast majority of patients who are seeking bariatric surgery as a solution to their obesity problem is precisely because their health status and physical limitations do not allow them to exercise regularly.

It will always be useful trying to make some slight changes in your daily routine, starting to exercise regularly before surgery is suggested, at least 30 minutes of light to moderate exercise.

However, failure to do exercise before surgery would not necessarily lead to problems during the procedure. The goal is make your body and your mind used to being active and acquire the habit of exercise.

Exercise should not be strenuous and intense, we just suggest you to modify certain simple aspects: if you sit for long periods of time, stand up frequently, if you are standing for long periods then walk short distances, avoid using the elevator or electric stairs, don’t use the closest available parking space to the doors of the convenience store but the farthest available, if your work and daily life does not allow you to exercise a lot, at least take a few minutes of the day or from the off hours to just walk, try walking your dog, try going to the park with your kids, etc. All these small changes together amount to a more active life than what you probably have now and are very simple to adopt.

Exercise will help particularly by developing a better lung capacity which will lessen the chances of respiratory complications in the immediate and mediate postoperative period.

A physical change that is actually mandatory before surgery is to reduce the size of the liver in preparation for procedure, this topic is explained in detail in the following posts:

Why follow a pre op diet when having a gastric sleeve surgery?‍

How long should I be on the pre-op diet before my gastric sleeve surgery and how much weight should I lose?

The list of suggested things to bring during your recovery in the hospital after surgery can be as large or small according to what you want to carry.

We suggest you carry with the essential, especially if you are traveling from afar. The overall patient experience is that they pack a lot more things than what they actually need for a short stay of two nights in the hospital.

Recommended list by Obesity Free:

• Strips to reduce intestinal gas eg: Gas-X strips or similar
• If you suffer obstructive sleep apnea and CPAP machine have, it is very important that you bring it with you.
• Some kind of oral moisturizer like chapstick and/or special swabsticks for this purpose like the lemon glycerin swabsticks by Dynarex ®
• Comfortable clothing, preferably sporty type for when you can walk in the hospital corridors
• Include comfortable slippers
• Bring all the medications you usually take at home, it is very likely you won’t need them since we will take care of that through the I.V medications we will administer you during your stay, but we do still recommend you bring them to the hospital
• Laptop, Tablet, Books, Magazines: During your hospital stay, you will probably feel so well for the day after surgery that you will get bored, so we recommend you to bring things to distract you at that time when you’re only resting on your room. And of course your friend or family member accompanying you will further benefit if you bring things for all the spare time he/she will have.
• Earings, jewelry, etc: This is something you should avoid bringing, however if you have to wear them we suggest that you take them off before surgery

FOREIGN PATIENTS:

If you come of the US, it is likely that you have specific questions about the things you can or should bring and list them below:

• Includes everything discussed above.-Mexican Pesos: you do not need to change your money to pesos since in most of the places you will be during your trip they accept dollars, we DO suggest you to get small denomination bills.

• Drinking water: drinking tap water is not recommended in Mexico, so we do suggest you to bring bottled water or any other beverage that your companion would like. In your case, as a patient do not worry, we will provide ice from sterile water, sterile water and eventually bottled juice. If your companion does not bring anything to drink also should not be a problem there should be plenty of safe options to choose from in the hospital.

• Every foreign patient that enters méxico will be requested to present his/her passport upon its return to the USA, so if you don’t have it, it is recommended to plan the tramit of this several weeks or even months before the day of your surgery.

The concept on how to prepare for gastric sleeve surgery can basically make us think about the implications of the surgery itself, however, the recommendation is that at home you should leave everything ready and in order with nothing pending to do upon your return home from hospital this will avoid you from worrying about issues that may interfere with your first days of rest and recovery.

Simple things like having clean clothes and whites, leaving the house clean, and have your pantry full of groceries with only things to be used as a source of hydration and nourishment in the first weeks after surgery, make sure you have ready a comfortable wardrobe at home, including, in the case of women, try having no wired bras available, a good choice would be the sports bras.

As we have previously exposed on various parts of our website and in our ebook, the assessment prior to surgery is almost as important as the procedure itself. If what you are looking for is that your surgery is to be a success and that the chances of complications are as low as possible it is mandatory to have an adequate preoperative evaluation, that the proper tests are performed for your specific case by the experts indicated by your surgeon.

We believe that we can not give specific guidelines and that each bariatric group has its way to carry out such an assessment but we suggest you when choosing your surgeon, to make sure there is going to be a preoperative evaluation.

Because of the nature of the procedure and lack of sufficient information in relation to weight loss surgery, its indications and great benefits, you probably feel reluctant to share with your loved ones your decision on having surgery.

This is a very personal decision and if you are an adult, you are in your right to decide for yourself; however, we believe that it would be ideal if at least your closest loved ones are completely aware of your plans on having the gastric sleeve surgery.

This is important because if you lean on them throughout the process, the preoperative and postoperative periods will be easier and bearable. We don’t mean by this that it is a very difficult process, however it requires a serious commitment on your part to manage to stick to the directions of your surgeon 100%, being the most important compliance with the liquid diet after surgery.

It is not uncommon to have family or friends who believe you should not undergo surgery, yet you know better than anyone what you’ve been through physically and emotionally to have taken the decision to undergo surgery with the purpose of solving your weight issues permanently. Do not despair if you feel they don’t understand or support you, we suggest you is to explain them your reasons and ask them for their support even if they don’t completely agree, if that is the case.

In Obesity Free we urge the patient to go to their pre-surgery consultations or calls with her husband/wife or closest family member to talk to them too and clarify any doubts they may have to calm their fears, since many occasions weight loss surgery patient family members are reluctant of the surgery because they fear for the safety of their loved one.

The process of instruction and patient education is not limited to the patient but also to close relatives in order to help you receive the necessary support both physically and mentally during your recovery.

As previously mentioned, as part of the preparation at home, we recommend that you prepare your pantry at home upon your return from the hospital. Just have to open it to get the different liquid foods and dietary supplements that you can and should take during the first weeks after your surgery. Again, it is difficult to provide a specific list as each surgeon recommends different things.

The recommendation is that stock your pantry with groceries to last at least two weeks.

For Obesity Free in general terms what you must have in your pantry is this:

• All kinds of powdered flavoring water, preferably low in sugar and calories.
• Some sort of preparing whey protein powder, there are multiple brands.
• If possible, tasteless protein powder to add to the food, this is difficult to find at times but a good example would be the products of the Unjury® brand
• Liquid protein “bullets”.
• Chewable tablet or liquid multivitamin or specific vitamins. e.g.: Multivitamin, Vitamin B12, Folic acid, Biotin, Omega 3 Capsules, Coenzyme Q10, etc. We don’t specify dosage and everything recommended since goes beyond this post’s purpose.
• Creams or soups Campbell’s® type for the second phase of the liquid diet.
• Gatorade® type high electrolyte fluids
• Low sugar Ice Popsicles
• Liquid Yogurt
• Fat free and sugar free puddings
• Frozen fruit for shakes
• Beef, chicken and vegetables Bouillon or broths
• Jello ®
• Water in large amounts

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What you should take out of your pantry: The list of foods, snacks, sweets, candies, etc that should never be in your pantry is very large, but in general terms during the first weeks, even months, you should avoid anything that is not liquid and that is high in calories and carbohydrates.

Example: flour products, soda and soft drinks, chocolates, chips or any other fried food, ice cream, candy, etc. In the first few weeks you should also avoid foods that in later stages can be safely eaten such as red meat and any other solid food. If you want to learn more about what food should be eaten in postoperative diet, you can see our post Post Op Gastric Sleeve Diet

** If you want to know more details of how we handle at Obesity Free the preoperative gastric sleeve diet and the reasons for such a diet visit these posts: Gastric Sleeve Pre-op diet and Why follow a pre op diet when having a gastric sleeve surgery?

The fact that you provide your bariatric surgeon with all the information related to your health plays a crucial role to minimize any incidents or any complications during or after your surgery.

You should consider not to hide or forget telling your doctor important data such as the medications you take regularly (prescription and over the counter), all diseases you have or have had in the past and the history of previous surgeries you’ve had especially abdominal surgeries, etc.

This information will be very useful to the surgeon to determine the course of action; both, in the preoperative period and evaluations he/she deems prudent for your case as well as for the postoperative period.

If you are traveling from afar to undergo surgery, it is important that you provide the above information and that you give an accurate number of your current weight at the time you book for surgery and not only an approximate weight.

It is very important to stop all those drugs that could affect your recovery during and after surgery: antiplatelet drugs such as blood thinners, herbal supplements, fish oil, etc.

In the case you take medications for the treatment of diseases such as antihypertensives (for high blood pressure), oral hypoglycemic agents (these and any medication for diabetes), beta blocker medications (to control some type of arrhythmia or cardiovascular disease), etc., you should inform your surgeon so that such conditions are handled timely and considered during the intraoperative and postoperative period.

Upon your return home you will likely be instructed to avoid medications in pill or tablet form, so it should be possible to find more suitable presentations for the immediate and mediate postoperative period, there are usually equivalents in liquid or chewable form, in the absence of such presentation, then you should investigate whether the drugs that you need to take regularly can be cutted or crushed so you can take them even from the first days after the operation.

Usually the only drugs that can not be crushed or cut are those that are extended-release, enteric-coated or come in capsule form.

It is highly recommended that besides of having the support from your loved ones, also consider joining some sort of gastric sleeve patients support group. There are various forums where patients give support each other and share their experiences.

But there is nothing like having your surgeon’s support or from someone in the bariatric group; sometimes patients do not receive the proper guidance from their surgeon and they make decisions that patients advise others not knowing if it could hurt others because everybody is different and this could jeopardize your progress.

There is no better patient than the one who knows thoroughly the details of the gastric sleeve preparation, its advantages and disadvantages, the risks of this or any other surgical procedure.

These patients have greater chances of success, not only in the immediate period after surgery but also in the long term because they know what they should do, what they should avoid and how to get the best results as far as weight loss is concerned.

At Obesity Free we will always be ready to support you, whether your surgery will be in a month, if it was a week or a year ago. You can always count on us.

It may seem that this recommendation is out of place since if you are choosing to put your life in someone’s hands is likely that you already have a good idea of his/her abilities and virtues as a surgeon and if he/she provides adequate support for this new stage in your life. However there are patients who do not take this aspect with the proper importance and base their decision for the place and person who will operate them according to the price that he/she offers.

We realize that money is an important factor but we strongly recommend it not to be your main motivation and guide your decision making. It will always be preferable to have surgery with someone who has the appropriate training and experience and can offer the best in terms of quality of materials used for your gastric sleeve surgery.

Analyze if during the preoperative process your surgeon takes the time to talk with you personally and answers all your questions, because if he/she does not do it before surgery, it is less likely that after surgery he/she will be less interested in dedicating time to you.

We also consider very important that your relationship with the surgeon should be direct and full of trust to help reduce your stress and anxiety, natural circumstances when a person is planning to undergo elective surgery.

If you go outside your city to have the surgery done, it is highly recommended that you book an appointment with your GP or PCP soon after having a surgery, because even though after the gastric sleeve surgery there is usually no need to monitor closely, at least in the sense of regular physical examinations, it is recommended that your physician is aware that you had surgery so that there is a precedent, specially if you suffer Type 1 or Type 2 Diabetes , hypertension, etc.

This is because of the very nature of the gastric sleeve procedure and as part of its benefits, it is likely that a few weeks after surgery you will need a dosage adjustment of your medications and even at some point, the definitive suspension of such drugs.

As you can see, there are countless things to consider when you plan to undergoing gastric sleeve surgery, all previous recommendations may vary depending on what bariatric group you choose.

Our final recommendation is to choose your surgeon after a thorough analysis considering how close is the monitoring and support that they provide when you request information on the procedure, as this can give you a clear guideline of what you can expect from him/her and his/her group in the postoperative period.

If you have any further questions about this topic, we invite you to share it to our e info@obesityfree.com

The gastric sleeve procedure in México is totally safe, we invite you to get a free evaluation with us and share your questions about the gastric sleeve cost in México, side effects, etc.

We invite you to read our most popular blog articles:

• Hair loss after Gastric Sleeve Surgery
• Gastric Sleeve Pre-op diet
• Gastric Sleeve Surgery Side Effects
• Pain after Gastric Sleeve

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Written by: Gabriel Rosales

Dr. Gabriel Rosales is a highly skilled, board certified surgeon in constant pursuit of learning the latest innovations in the weight loss surgery field to give his patients the best care possible.

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